HomeMy Public PortalAbout8920 BROADWAY_Sewer__ E
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S - 3% APPLICATION FOR PERMIT
'eDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT of SUILmrva LOCALITY
FOR APPLICANT TO FILL IN cnoss si..
LEGAL
DESCRIPTION LOT NO OWNER
co
BLOCK TRACT MAIL
2�3 ADDRESS
NO. OF BLOTS. CITY TEL. NO.
SIZE OF LOT J� NOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
' CONTRACTOR
ADDRESS CONNECTION DATA
STATION DEPTH
CITY TEL. N0. - MANHOLE REFERENCE UPPER
1, r iJ'7 f1 STATE T LOWER
REGISTRATION N0. �j j "J 6/-f��/ ❑ COUNTY ' A D�� /
NO. DESCRIPTION OF W0 FEE 11
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS ANO/OR DRAINFIELD @ $ 3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EXTN.,CESSPOOL.DRYWELL,MANHOLE CV $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM (Ld S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ACONNECT ADDITIONAL BLDG.OR /9 !, STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $.I.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE aElMauasEMEnr FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS-DAY DAY OF 19 CONNECT ADDITIONAL ,�e
OWNER ORyl g i 1 BUILDING OR WORK - -s
OWNERS AGENT_T�_P A/l-J SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF -ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
51SEEP.PIT(S) ❑ CESSPOOLS[3OF PER E — II�
OF ERMITTE 1 I
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION
,- / ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CR. M. 0. /CA✓SH
h4507u JAM g 4 2.00 In
e - °
B8E_BAPPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County Of LOB Angeles BUILDING ]"r�WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY j Atm M177A ��
FOR APPLICANT TO FILL IN NEAREST I
y, CROSS ST.
DESCRIPTION LOT NO. � C G .�Cc�� /OWNER
BLOCK TRACT jt���. ��} � r� MAIL 5 S F �� eOl
AO DRESYLLL' C n /
SIZE OF LOT NOW ONNO- OF
BLOTS .3 CITY r - EL. NO.
Qk49e[ S
USE OF _
_BUILDINGS �-t �t/C//a>l1,lj„ DISTRI4CTN O. GROUP / MAP
CONTRACTOR P�lu .Z-1 n\ (il�79: — /� ` ? /-1B{— 1
ADDRESS 10, �• A /�kC JC -)� CONNECTION DATA
CITY Yj DL A - A TEL. NO. t• ��/ ` STATION DEPTH
e ATE MANHOLE REFERENCE UPPER
REGISTRATION NO. C ❑ COUNTY y- LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO - Y. TYPE OF CONNECTION LENalrH Mom
CURB P.L. M.L. TO P.L.
_ PUBLIC SEWER Q 5 3.50 _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P.
WORK TO HOUSE SEWER 1.00F r Co. IMP. NO. JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PE'RM T N0.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK„ SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARG
PERMIT CONNECTION ARGE FEE
OWNER'S s 1 00
AUTHORIZATION TOTAL FEE REIMS SEMENT FEE
IHAVE MED CON
TRACTORTOCONNECT DATE O THE ABOVE CTED WDESCRIBED EXISTING ITH THE HEREIN A DWELLING � APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS—DAY'1/ NEW HOUSE SEWER
ROF 19_
OWNER OR �_� CONNECT ADDITIONAL
OWNERS AGENT iiii ! .I BUILDING OR WORK S
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR y
LICENSED AS REQUIRED BY LOS ANGELES COUNTY,AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEG6L OWNER OF THE ABOVE ABANDON HOUSE SEWER
v
DESCRIBED RESIDENTIAL PROPERTY. ��i / BACKFILL SEPTIC TANKS r./! Y�'�Gh - SEEP. PIT(S ❑ CESSPOOLS
SIGNATURE r3 /'i �'i.a%.��/.—
.
OF PERMITTEE
WILLIAM L FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
..ICos 0 1 63S� JUL 27 2.00