HomeMy Public PortalAbout9839 GARIBALDI AVE_Sewer__ D
SINE-683 I1-SS APPLICATION FOR PERMIT 1
S 8 E•6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer _
County of Los Angeles BUILDING`]eer'--
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FO FP AC T FILL CROSS ST.
LEGAL OWNER s✓
DESCRIPTION LOT N0. ,,;;t`_-->-¢: >•..c_ti..;+'i•r_.-.�.
MAIL ,-•��_e '
BLOCK TRACT ADDRESS
NO. OF BLDGS. i'-
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF �y
BUILDINGS r - DISTRICT N0. GROUP MAP
BK PG
CONTRACTOR: j 'G ' L WAV
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// CONNECTION DATA
ADDRESS:rf.1fZ_ rte_...,.,, , .,q ;�, ,. r
,J 6�' =L. STATION / DEPTH GY
CITI(�e+. . ` , EL.N0. v MANHOLE REFERENCE UPPER
W- STATE
REGISTRATION NO. ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CTION LENGTH FROM
PUBLIC SEWER @ $3.50 -��
Y.
C'QRB P.L. M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
I
EXTN.,CESSPOOL,DRYWELL,MANH0LE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE ER
PRIVATE DISPOSAL SYSTEMG TO @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR JJ STATE ENCROACHMENT
I
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00
AUTHORIZATION TOTAL FEE ,,^ REIMBURSEMENT FEE h !• �_. y
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
R
TACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER /✓.,+ orf
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
LDDRES AND/OR DRAINFIELD
EBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
NG AND SEWERS. SEWAGE DISPOSAL SYSTEM
EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFABANDON HOUSESEWER
RNIA OR THAT I M THE L AL OWNER OF THE ABOVE BED RESIDENTIA OPERTY.� BACKFILL SEPTIC TANKS❑ _URE � SEEP.PIT(S) ❑ CESSPOOLS /"RMITTEE` �`+ rl
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIONjROBERT . WOOD, CHIEF PLBG. INSPECTOR
CK. M.O. �AS.�
2288 JUN 261 A 10.50