HomeMy Public PortalAbout9833 GARIBALDI AVE_Sewer__ DF.PA.R33410rT OF OOUNW ENCINEIIi SEWER-SEWAGE DISPOSAL. 1
DMSION OF BUnMING AND SAFE'T'Y t7T3 ERMIT APPLICATION
COUNTY OF LOS "(iEL1�
WILLIAM J. FO)(, COUNTY ENGINEER BUILDING
DRESS
AD1
9� 3 R APPLI RL4. IN LDGAu ,
BUILDI GNEAREST
ADDRESS ' GROSS ST. CnrnkA 'P^
LOOALI DISTRICT NO. SERIAL M0. PERMIT NO. C
NEAREST 5 S
—
CROSS ST. ECEIVED BY Reams for lupwUss DATE ISSUED
OWNER
MAIL U>SE Z OCCUPANCY MAF
ADDRESS RK pe
CITY TELN0. -�42L- g�
CONTRACTOR �1f+7't�j✓� s*'� m IMF.N0.
ADDRESS .�'�/ I�' s5 / JOB.N0.
CITY TRUNK PERMIT N0.:_
(TATE
REGISTRATION NO. d NTY ROAD PERMIT N0. `Z
LEGAL STATE ENCROACHMENT
DE80RIPTION LOT N0. PERMIT N0.
BLOCK TRACT �j INDUBTRIAL
WASTE APPROVAL
NO.Of BL
SIZE OF LOT �3 3Db NOW ON LOTS' CHAROE8
BUILDINGS Bn CONNECT HARGE FEE
BUI
N0. DESCRIPTION OF WORK FEE
-WOUSE SEWER DONNEOTIN 0 REIMBURSEMENT F
PUBLIC SEWER 0 0 &H RECEIPT N0. E BV
HOUS9 SEW511 CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
C,0iktOT AbOlTibmAUnEXCEPT"ION REOORDED
WORK TO HOUSE SEWER I.w
ALYER OR RtPAIR I NO. DATE BY
SEWER OR DISPOSAL SYSTEM 1.90
DISCONNECT AND ABANDON SEWER
AND OR DISPOSAL SYSTEM I.10 CONNECTION DATA
-9EPTIO TANK.SEEPACIR PIT OR
PITS AND OR DRAINFIELD 2.00 STATION -r , DEPTH
OE68POOL—D ELL
SPECIAL CONDITIONS ONLY LEI $I TM PE FEBENCE
TYPER ECTI LENGTH FROM I
OD 4M;6 MA_TO P.L.PERMIT t 1
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRAOTED WITH THE HEREIN NAMED
OONTRACTOR TO CONNEOT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIO SEWER
SIGNED THI Y OF Iq NEW HOUSE SEWER _5 -
OWNER OR CONNECT ADDITIONAL
OWNERS AGE BUILDING OR WORK
SEPTIO TANKK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APFLI- CI SSOL I] DRYWELL
CATION AND STATE THAT THE ABOVFO
E 1E GO AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER OR
REGULATING PLUMBING AND S"ER& SEWAGE DISPOIIAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOB ANGELES GOUNTY
AND STATE OF CALIFORNIA OR THAT I Ali THE LEGAL 0 ABANDON HOUSESEWER
ER OF THE ABOV ED DE TIAL PROPERTY. 0 N []
SIGNATURE I BEfiP.PIT(S) ] CESSPOOL`❑
OF PERMITTEE -
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