HomeMy Public PortalAbout9837 GARIBALDI AVE_Sewer__ Y �
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` 64APPLICATION FOR PERMIT
COUMT OF LOS ANGM SEWER—SEWAGE DISPOSAL 1
DEPARTMtNT OF COUNTY ENGMM
aDING AD SAFETY D MON ��
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LEGAL O*11
DESCRIPTION LOT NO. ER
BLACK TRACT MAIL
ADD
0.OF SLOBS. /
SIZE OF LOT Now
ON LOT 4-
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DATA
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REGISTRATION NO. CCOU AMU OLE RGR6iR1( /
No }� �JDESCRIPTION
OF
PUBLIC9$E7ERECTINO TO / '
if
TTTE OF CONNECTION LENGTH FRO■ /
SEPTIC TAX[,SEEPAGE PIT OR T. CURD P ■ TO P.
PITS AN OR DRAINFIELD 4p S3.m
Fl-ft SEEPAGE PIT DRAINFlELD
9 S1,00
OL1E R CONN-ECTI G TO
P.C.N0.
FQML
00 CO.IEP.N0. JOB Nd.
WONN �C E UDIIIONAL BLDG.OR TRUM[PERMIT NO. ROAD PERMIT N0.
1.00
R. O BANDO SE I STATE ENCROACHM[NT
PERMIT NO.
INDUSTRIAL
WASTA APPROYA
ORB
QWNErs PE113UT CONNECTION CHARGE FEE
AUTHOHII.ATION I TOTAL FEE REIMBURSEMENt FltlS
I HAVE AT THIS DATE A CONTRACT WITH TH[ HEREIN NAM® CON,
TRACTOR TO CONNECT THE ADORE DESCRIBED _EXISTING PWELLING APPROVALSDATt IXSPkC`OE'SSIGNArOx
TO THE PUBLIC SEWM
SIGNED THIS DAY OF 9_ NEW HOUSE SEWER
DWNSR OR CONNECT AD DI 'ORAL
0WNERS AGENT�� BUILDING OR UOM
ADDRESS SEPTIC TANS SEEP PITS))
AN OR DRAINF ELD
1 HEREBT AC[NOWL.EDGE THAT. 1 HAVE READ THIS APFLICATION
AAD STATE 'THAT THE ABOVE IS CORRECT AND AGREI TO CO] LT C[SSFppL DRTWELL
WIT�I ALL OUNTT ORDINANCES AND STATE LAW'S REGUL► X0 ALTAR,REP IR, MER OR _
PLUY>�ING ASID SI7EERS. SMAGE DISPOSAL STSTEM
I HEERR��lRT CERT[FT NT I A■ PROFERLT REGISTE3ID AN OR DISCONNECT PLUG AND
LICENEEb AS REQUIRED 0T LOS ANGELES COUNTT AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AY T}1 LEGAL OWNER 0► THE ABOVE
DESCR16FD REBID IAL PROPEAT�. BAC[FILL SEPTICTANKS
SIGNATURE S .PITS CESSPOOLS
OF PERYI
�r a VALIDATION--)0. ROBERT iA.A WOOD
CL a uat nrrlaatvtatrRa lrEci-uuvtCwL lfftougtTQ[
�0 8 8 Ate 1. 1 D 25.00
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UG41D °
7APP�..-ICATION FOR PERMIT
/J�41D COUNTY OF LOS ANCMM SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENS y '
BUU.DI NG AND SAFETY DIVISION ADDRh7f / r
r.fvRrr_ LOCALITY
NEAREST
FOR APPLICANT TO FILL CROSS
LEGAL OWNEQ
DESCRIPTION LAT N0. .
BLOCK TRACT W L C
zz Jt
ADDRESS L+-
N0.OF B LD GS. ;7-60SIZE OF LOT NOW OX LAT Cm TIEL USE OF DISTRICT NO. GROUP YAP DTBUILDINGSCONTRACTORADDRESS COM&C 1OH
crrT TEL NO. p Al N6 DOTH
3G TATE HOLE REFERENCR J ! CZ-UP
REGISTRATION N0. 7 �+."-r
No u� EEpDESCRIPTIONO R
PUOLICSSEItlEaWE
CONNECTING TO O :3.00
SEPTIC TANK,SEEPAGE IT OR T. TYPE OF CONNECTION R.L.TO LEMM FROM
PIT$AND/OR DRAINFIELD
OVERFLbW SEEPAGE PIT,DRAIXFIELD
L. LL
HO 9E SEWER CONNECT GD15PQML n3
IA L TO F.C NO. - -
Sim CO.IMP. NO. JOB NO.
CONNECT ADDITIONALR BLDG.OR
WORK TO 0 IEWE TRUNKPERIItNO. QOAD PERMIT M0.
A E A O ABAXD N HOUSE I00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL -
WASTE APPRO A
CHARD
OWNER'S PEHMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FE;
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVI DESCRIBED EZ]STING DWELLING APPSOVALS Mn INSPECTOM'SSIGNATURX
TO THE PUBLIC SEWER.
SIGNED THIS SAY OF ➢_ XEW HOUVE SEWER G
OWNER OR ^^ CONNECT ADDITIONAL
OWNERS AGENT oe f l BUILDING OR WORK
ADDRE SEPTIC TAMC,BEEP.PFT(S)
AX OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPDOL DRTvrELL
WITH ALL COUNTY ORDIJ ANCEI AND STATE LAWS REGULATING ALTER, EPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGEDISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AN FROPERLT REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AXR STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOYB
DESCRIBED RESIDE ROPERTT. BACKFILL$ C TANKS
SIGNATURE PIT $ CESSPOOLS
OF PERYI
OF VALIDATION ROBERT A. WOOD
DL L 0. CJIf9 SUP?U"nSINQ YMCI-IANICAL INCalRB N _
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