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Home My Public Portal About9916 GARIBALDI AVE_Sewer__ 0-63 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS n WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. - LEGAL DESCRIPTION LOT NO. OWNER .� MAIL BLOCK TRACT 40C/lw ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP I MAPPROCESSED BY BUILDINGS /BK P CONTRACTOR ADDRESS C ama gyp, CO�•NNECTION DATA _ / STATION DEPTH CITY �7 TEL. NO. / _ ❑ STATE MANHOLE REFERENCE REGISTRATION NO. El COUNTY f LOWER NO. DESCRIPTION OF WORK FEE TYPE F NNECTION LENGTH FROM HOUSES WER CONNECTING TO Y. M.L.TO P.L. >„ PUBLIC SEWER @ $5.00 P.C.NO. O_ SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. JOB NO. O PITS AND/OR DRAINFIELD $10.00 U HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 OC CONNECT ADDITIONAL BLDG.OR R AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE O WORK TO HOUSE SEWER @ $3.00 • 06 U OVERFLOW SEEPAGE PIT.DRAINFIELD W EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 CL N ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT s 2 00 AUTHORIZATION TOTAL FEE o CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS�DAY OF 6&1 196 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PITS) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE D9ESCRIBED RESID TIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE / j�}//t BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ✓- ��,////// /// ( -G1�J SEEP,PITS) ❑ CESSPOOLS ❑ 'VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. Li'to 4 9 6 5:o OCT 1 6 1 0 D 5.0 ON v D S&E-688 11.55 APPLICATION FOR PERMIT 1 S 8 E•6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I POSA L Department of County Engineer County of Los Angeles BUILDING ^� JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS T: 424&a4J FL iQ& LEGAL OWNER DES TION' LOT N0. ACTjrAQ O ADDRESS !(r(,tiF/Laces(, SIZE OF LOT NONOW F.OF'ON LOGS. CITY Xj TEL. NO. ` OT USE OF BUILDINGS •d r DISTRICT GROUP MAP BK PG CONTRACTOR ADDRESS ? J, CONNECTION DATA CITY �4- � TEL. NO.� �fy[� STATION DEPTH MANHOLE REFERENCE ❑ STATE / OWER REGISTRATION NO. ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CURB TION�r MELGTOH P FROM PUBLIC SEWER @ $3.50 0(� SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD '•"► P. C. N0. EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 CO. IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO /01,� lr;�a PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT 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 OWNERS PERMIT $ 1 00 AUTHORIZATION I TOTAL FEE - REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r TO THE PUBLICSEW NEW HOUSE SEWER SIGNED THIS j DAY OF 19JT CONNECT ADDITIONAL OWNER OR Lw BUILDING OR WORK OWNERS AGEN SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE HIS PPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS COR CT AND AGREE TO COMPLY _ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL P P RTY. BACKFILL SEPTIC TANKS❑ / ,�,- SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS -5Ae OF PERMITTEE ppp�TT JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIOL`J� ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. M.O. � ,:1(ro8588LL AY27 4 4.5 �