HomeMy Public PortalAbout9941 GARIBALDI AVE_Sewer__ Tz"LE CITY
1
70Ae�A84zD 0-0D APPLICATION FOR PERMIT '
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DtPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION
BuILESG
1 E. Garibaldi
Go= Fn BSADDIB
WlA ' SUPT
of HuMcHnq
LOCALITY Temple City
NUR
FOR APPLICANT TO FILL IN Agneps
DESCRIPTION LOT NO.�rSI D .rD, OWNERDavid Nicalat
BLOCK TRACT I 3 7 MAILADDRU• 1 Garibaldi
NO. OF B4DGS.
SIZE OF LOT NOW ON LOT cl III.. NO.
usk OF
■LHLDINGf Res
DIBTRICf NO. PROUC4 MAP PROC
Pa
dDNTRAcToR sguare Deal Sewer Service
d �K -- kcpl
ADDRESS CONNECTION DATA
CITY - Monte TIL NO. _2020 STATION DEPTH
GATX MANHOLE REFERENCE
REGISTRATION NO. COUNTY LOWER
NO. DESCRIPTION OF WOR FEE TYNE OF cO N L[110TN FROM .- -
HOUSE SEWER CONN[CTI NO TO Y. UR■ P.L. Y.L.TO P.L }
PUBLIC B[WER 0 im.00 O•
SEPTIC TANK.SEEPAGE PIT OR P.C.NO. (�
PITB AND/OR DRAT N [LD 41 510.00 CO.IMP.NO. JOB NO. l?J{
HOUSE SEWER CONNECTING TO TRUNK P[RMrT NO. ROAD PERMIT NO. Q(
PRIVATE DISPOBAL SYSTEM 0 67.00
CONNECT ADDITIONAL B G.OR AFFIDAVIT •Aft[■ [AIEB[[T RECORD.INSTR.NO. DATJf
WORK TO HOU; -PK SEWER a 51.00
OVERFLOW SE[PAG[TrT.DRAINFIELD
EXT N..CESBPOOLDRYWELL.MANHOL[49 66.00 a
AL R.R AIR OR A D U■ HWY. OR ST.WIDENING H
SEWER OR DISPOSAL SYSTEM 65.00 STATE KMCROACHM[NT
PERMIT NO.
INDUSTRIAL
WAST[APPROVAL
CHARGES
OWNER'S PERMIT s 21 00
AUTHORIZATION I TOTAL FEE Ufj CONNECTION CHARON FE[
'I HAVE AT THISDATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURB[M[NT FE[
TRACTOR TO GONNECf THE ABOVE D[SCRIB[D [XISTINO DWELLING
TO THE PUBLIC SEWER. APPROVALS DAT[ INSr KCTop;a GIV.TU R[
SIGNED THIS DAY OF 19_
OWNER 0A NEW HOUSE SEWER r
OWNERS AGENT CONNECT ADDITIONAL
RUILDINO OR WORK
ADDRESS
I HEREBY f.CKNOWLEUO[ THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S)
AND STAT[ THAT THE ABOVE 10 CORRECT AND AGREE TO COMPLY AND/OR DRAINFI[LD
LILD
COUNTY ORDINANCES AND STATE LAWS REGULATING
AND SEWERS. CESSPOOL ❑ DRYWELL ❑
Y CERTIFY THAT 1 AM PROPERLY RKGIBTERED AHD/OR ALTER.REPAIR,SEWER OR
AS REQUIRED BY LOS ANGLES COUNTY AND BTATI OF SEWAGE DISPOSAL SYSTEM
IA OR THAT I AM THE LEGAL OWNER O AND INTEND TO DIfCbNH[CTPLUG AND
, THE ABOVE DES RIBRD RESID[NTIA PR RTY. ABANDON HOU;[SEWER
E ❑ITTEE BACKFILL SEPTIC TANKS
u pCW FOOL
ATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
3026 "23100 7.00N