HomeMy Public PortalAbout9831 GARIBALDI AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGIIXS l
WILLIAM J. FOX, COUNTY ENGINEER I ADDREISS C(a_ktj -ICI , q
FOR APPLICANT-TO FILL IN LOCALIT� '
ADD EBUILDISS NG !�0��j/31 — NEARESTCROSS ST. C) QV, ilC
LOCALITY (itR.� DISTRICT NO. SERIAL NO. PERMIT NO.
-� A S
NEAREST
CROSS ST. C(/ `'•'---- �^- ''w
CEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS
�JV r USE ZO OCCUPANCY BK MAP PB
CIT T N0. " !r�''.. A-%
CONTRACTOR -x� CO.IMP.N0.
ADDRESS 2'9-� 51 , j/ IJ S / JOB.N0.
CITY TEL.NO. Al��' TRUNK PERMIT NO. N'
+� STATE
REGISTRATION NO. 7 8 COUNTY ROAD PERMIT NO. '� C� 34r q C
LEGAL }c STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK j TRACT �._ 6 �" I INDUSTRIAL
APPROVAL
SIZE OF LOT d3 30 C) NOW ON LOTS
CHARGES �1
USE OF
BUILDINGS � ) -LC CONNECTI HARGE FEE ,
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOREIMBURSEMENT FE
PUBLIC SEWER 0 $ 3.50 3 r0 RECEIPT NO. TE I BY
})
4- HOUSE SEWER CONNECTING TO �.
PRIVATE DISPOSAL SYSTEM 1.00 t
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED\
WORK TO HOUSE SEWER 1.00 X
ALTER OR REPAIR EXISTING
ES
NO, DATE I BY I
SWER OR DISPOAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION I Q —2 — DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ��2 ) MANHOLE REFERENCE LOWE
_ YPE OF CONNECt10N LENGTH FROMil
OWNERS PERMIT $ 00 Y. w1iNi M.L.TO P
AUTHORIZATION I TOTAL FEE e 15-�
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE ;
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-..._.__
DAY OF...........L._ __ 19� NEW HOUSE SEWER -S
OWNER OR _ CONNECT ADDITIONAL I
BUILDING OR WORK
OWNERS AGENT. Zn -•---•-- �
SEPTIC TANK,SEEP.PIT(S)
4
ADDRESS- ::....`✓.. taZ - -'Lf:rf-G..-.:..._... AMD/ORDRAINFIELD
9 _.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] DRYWELL
CA
TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE _
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THATRE AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT.a AM THE LEGAL OWN- N
ER OF THE ABO Rg= CRIBED REST ENTIAL PROPERTY. BACKFILL SEPTIC TANKS F]
SEEP.PIT(S)[-] CESSPOOLS❑ 411
SIGNATURE Q-r•�•�•�+`^s
OF PERM ITTE _.�--- --
7GA642A 663 7/53