HomeMy Public PortalAbout8912 & 8912 1/2 BROADWAY_Sewer__ 7GA642D
CE606.8.58 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL. 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING � c /W 4•
JOHN A. LAMBIE. County Engineer ADDRESS .rye d
CASSATT D. GRIFFIN. Sup't of Building LOCALITY / _ f,I tole
FOR APPLICANT TO FILL JX
NEAREST
CROSS ST. f1?A -IS�]' 1164 >r'�. L '
LEGAL OWNER �O 6dPi V� 1'►-a L (�
DESCRIPTION LOT N0.
BLOCK TRACTMAIL �.
ADDRESS
N0. F LDGS.
SIZE OF LOT NOW ON LOT Y CITY 7r A4 /C TEL.N0. .
USE DI DISTRICT N0. GROUP MAP P OCESSE
BUILDINGS /�( C � ..�
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CONTRACTOR C 1 !'
L ff' z;�2�
ADDRESS w e k^ CONNECTION DATA
CITY e t TEL. NO. 7 ,l ,�' STATION DEPTH
REGISTRATION NO. ® t�"7 0 rTATE
COUNTY MANHOLE REFERENCE UPPER
No. DESCRIPTION OF WORK FEE LOWER
A
HOUSE SEWER CONNECTING TO U
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD '
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TOP.C. N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 C MP.NO. JOB N
CONNECT ADDITIONAL BLDG.OR TRUNK P 0. DAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE , STATE ENCROACH
SEWER OR DISPOSAL SYSTEM @ $1.00 g) PERMIT NO.
INDUSTaMf-
-
WAST PPROVAL
' CHARGES
OWNER'S PERMIT S 2 00 CONNE roN CHARGE FEE
AUTHORIZATION TOTAL FEE gp 40 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
TO THE PUBLIC SEWER.
SIGNED THIS SAY OF / 19_ NEW HOUSE SEWER
OWNER OR _� ,`/ CONNECT ADDITIONAL
OWNERS AGENTy�+ BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, RfiPA+R, SEWER DR
PLUMBING AND SEWERS. SE-WA,.(}_� a^��s�g+E*
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THffl LEGAE, OWNER OF THE ABOVE
DESCRIBED RESIDENT PROPE TY. a BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE
®r �VALWATION ROBERT A.WOOD
M.D. CAgg SUPERVISING MECHANICAL ENGINEER
Lwa
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