Loading...
HomeMy Public PortalAbout9947 GARIBALDI AVE_Sewer__,mow 8.59 APPLICATION FOR PERMIT 99 7 ?947X C0IINT7 OF LOS ANS- SEWER—SEWAGE DISPOSAL 1 MmTMENT OF coax" EN(M= W=MG AND BArE�T3T� 101MON FUrl,=Glw&w rollff A�TFFIX �'l d 9=m TIFOR APPLICANT TO FE�l IN T. �. . DEBCRIGPATIION LOTMO.W• ,ted 46• 3150 OWNER /yd j`l v S BLOCK TRACTsfr. r • (�4a- MAI ADDRESS aS. am OF NOW ON LAT CrTr TEL NO. Mr.. "L�. DISTRICT NO. GROUP YAP rBT Co11TRACTo ; 1 ar I' ADDRESS �� GOIMCI ON DATA CmTEL NO. BTATIOM DEPTH p STATE MANHOLE REFE>tEIICI UPPIM REGISTRATION No. ! COUXTT LOWER No. HH �8E] E1RIP WORKFEE PUBLICSSE�I(.PA MXYCTIKG TO ,Oo H1YF� TTPE OF cbmmtpiom LENGTH FROM WC TION[.SEEPAGE FIT OR T. CURB P. R.L.TO P. PIAND/OR DRAINFIELD OVERFLOW SHI<PAL.GE PI DRAl11PIELB HO SE SEWEA CONNECTING TO P.C.NO. 1�Ag DISPOSAL ST DO CO. 110. JOB N0. CoR%TDA E R �'J TRUNK PERMIT X0. ROAD PERMIT X0. A B N HOU I STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WAM APPROVAL CHARGES Off'$ 2 OO CONNIICTION CHARGE FEI A THORMATION TOTAL FEE REIMBURSEMENT FEJ: ITRAACTEOR TO CONT THIS NEECCT ATE THE ABOTE DESCRIBED HEKIIZT"Na PWE[,un OVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC RFWE➢. SIGNED THig nn Q-F 9T_ NEW HOUSE SEWER OWNER bR CONNECT ADDITIONAL 1, ! O"53kSAGEMT / •/� BUILDING OR WORK ADDRESS SFFTIC'I N SEEP.PIT(3) AX OR DRAIXFIELD 1 HEREBT ACKNOWLEDGE THAT 1 HATE READ THIS APPLICATION AID STATE THAT THE ABOVE 15 CORRECT �LI1D AGREE TO COMPLT CESSPOOL DRTWELL WITH ALL COUNTT ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWE1te. SEWAGE DISPOSAL SYSTEM 1 HERHBT CERTIFT TBAT I AM PROPERLT REGISTERED AIID/OR DISCONNECT PLUG AND LICEN AS REOUIRED BT MGE COUTR /44D STATE OF CALL T 1 A{�L(OC�HE 1.EG L CO Il THE ABO VY �XD011 HOUSE SEWER ��Ay,p�1 {• BAGKFI IT 8) C TAM P 7 ��Y^^ SEEP.PIT S MPO-OL, OF PER■ ow I ■ L VAI, 0. CA= WOOD �. 0. `� HUFSE RYL8INO MECHANICAL NICAL YNOINBMt E 'I{,o 6 1 2 $� Fu 5 1 0 A �-