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HomeMy Public PortalAbout9953 GARIBALDI AVE_Sewer__r D•F.PARTl%MNT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENQINEER I BUILDING GJQ,['/_5 ADDRESS -// 7`J ,C /7 FOR APPLICANT TO FILL IN LOCALITY , BUILDING ��/ - r� /'--a`�/�/� �/ NEAREST / S ADDRESS V (� P C )_ CROSS ST. LOCALITY '�r."e /�,/ / / DISTRICT N0. A SERIAL N0_ PERMIT NO. N-0- NEAREST IGWK G!/Gf T" d�Lz .J A �.. --`- 7/ �% S CROSS ST. ' RECEIVEJQBYf. Ready for Inspection D TE 1 88 ED OWNER /A AxAdll22 MAIL OCCUPANCY AP ADDRESS 4' ha1�iUSEZON@ BIC PG CITY �p c TELAO. / J I �ES I Z_ Z CONTRACTOR /Z�' r `a rcCG�f a- CO.IMP.NO. l33 Z �9 ADDRESS 1010/ JOB.NO. CITY ( TEL.R6q./'�-f,/y� 33 TRUNK PERMIT NO.�-���---�- SiATE REGISTRATION NO. y-7 ( ✓ 8 COUNTY *^ C ROAD PERMIT N0. i DESCRIPTION LEGAL LOT NO.Z'SD/ Gl/��, G O STATE ENCROACHMENT p. PERMIT NO. BLOCK TRACT SAN A TQ INDUSTRIAL - WASTE APPROVAL SIZE OF LOT ��X 3t� NOW,ON LOTS CHAR S USE OF / BUILDINGS /� �- �� CONNECTION CHARGE hE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLICSEWER 0 $ 3.50 RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR / D EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 0 ALTER OR REPAIR EXISTING DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTI014 DATA SEPTIC TANK,SEEPAGE PIT OR /( PITS AND/OR DRAINFIELD 2.00 STATION .3 �/� '� DEPTH C/ SPECIAL CONDITIONS ONLY 2.00 © / MA FERENCE /� O S E PP£R ✓a f• :#/ - lA1AfGii PE OF CONNECTI LENGTH FROM OWNERS PERMIT s I 1. 00 Y. 4:1116aft 4_ M.L.TO P.L. AUTHORIZATION I TOTAL FEE O 1 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... DAYNEW HOUSE SEWER OWNER OR -a _ CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK {. SEPTIC TANK,SEEP.PIT(S) ADDRESS........ l_P.- _G_�-- _----._. _....:_.. AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE A AVI`e RE-"'T418 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 IAM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND DISCONNECT ABANDON HOPLUG PLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE 'k ( � SEEP.PIT(S)� CESSPOOLS OF PERMITTEE---=------- -1/- ---- ..................--- 76A642A 663 7/53 ,