HomeMy Public PortalAbout9949 GARIBALDI AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO ILL IN LOCALITY f70,
BUILDING NEAREST
ADDRESS C CROSS ST. 6l/
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.� '2
y .. C
F V
NEAREST - -�
CROSS ST.
RELEIVEEL Ready for Inspection DA-K ISSUED
OWNER
MAIL USEZONY OCCUPANCY `1MF=
ADDRESS " BK PG
CITY TEL.NO.
CONTRACTOR CO.IMP.N0.
ADDRESS JOB N0
CITY TEL.NO. fel7 TRUNK PERMIT NO.
REGISTRATION NO. SATE
COUNTY ROAD PERMIT NO.
LEGAL
,r
Q DESCRIPTION LOAF,rQ ®Q E.,+?8Q STATE ENCROACHMENT.
DESCRIPTION LOT PERMIT NO.
BLOCK TRACT INDUSTRIAL
*TASTE APPROVAL
SIZE OF LOT '7 a �060NOW ON LOTS CHARG
USE OF
BUILDINGS CONNECTION CONNECTION CHARGE F
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT N0. ATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD6.OR �Q EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 (l I DATE I BY
ALTER OR REPAIR EXISTING NO.
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
S fl-
EP C TANK,SEEPAE
PITS AND/OR DRAINFGELDIT OR 2,00STATION
" +. _5 DEPTH
DEPTH '
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
_ TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; I Y. CURB P.L. Ma TQP f=
AUTHORIZATION TOTAL FEE �'�� ' '
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS/..�.,�.D Y OF.. _.. _..��..19__ , 'NEW HOUSE SEWER
OWNER OR ✓ko CONNECT ADDITIONAL
OWNERS AGENT _.. ----------- _ BUILDING OR WORK
_..
___.... SEPTIC TANK,SEEP.PIT(S)
ADDRESS_._..........--
....-•--•----�-----_•.----•---..._-•....................-- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL(] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO.COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SEEP.PIT(S)� CESSPOOLS
SIGNATURE
OF PERMITTEE-- - -.._. ...'^•........... - '`=-f=.._:._:..
76A642A 663 7/53