HomeMy Public PortalAbout8928 BROADWAY_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT- APPLICATION
COnNTY. Ojr LOS ANGELES
W .I
ILLIAi.I� ...F`, X. COUNTY ENGINEER I ppp KESS
R APPLICANT TOS FILL IN LOCALITY ��J
BUILDING 92B b ala/7�_ A-. ._ J CROSS ST.
NEAREST
ADDRESS �,�T JJ1' '�•�4(.�II-'G•
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
eq
CROSS ST. RECEIVED BY RaaOY for Impaction DATE ISSUED
OWNER -DC
ADBKIL SS a ^ USEZONE OCCUPANCY MAP PO
CIT (jtiL TELNO.
CONTRACTOR �- C/r/ CO.IMP.NO.
ADDRESS ' ,
JOB.N0. _
CIT TEL.NO. TRUNK PERMIT NO. \
X.ATE
\REGISTRA N N0. BOC60UNTY ROAD PERMIT N0.
LEGAL '� STATE ENCROACHMENT
DESCRIPTION LOT N0. o� ^ PERMIT NO. 1
BLOCK TRACT/ I I'� J,�� !�/ INDUSTRIAL /
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER ® $ 3.50 RECEIPT NO. DATE ' BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTE M 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. DATE ISY
SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE
REFERENCE
ERLOWER
TYPE OF CONNECTION LENGTH FROM
V. CURB P.L. - M.L.TO P.L.
OWNERS PERMIT $ 11 OO
AUTHORIZATION I TOTAL FEE I IL 100
IHAVE THIS DATE CONTWITH THE HEREIN NAED
CONTRACTOR TO CONNECTR ED THTE ABOVE DESCRIBED EXISTING APPROVALS INS P ECTOR'8 SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER —
SIGNED THIS.........___DAY OF..__—.__—..19_. NEW HOUSE SEWER J'7
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........._...
: BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS..._................:..............................................._........... AND/OR DRAINFIELD
I HEREBY'ACKNOWLEDGE THAT I HAVE HEAD THIS APPLI• CESSPOOL Q 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. SEWAGEEPAIR.SEWER R
I NERE BY CERTIFY THAT 1 AM PROPERLY REGISTERED EWACNDISECT PLA AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
'ER OF THE ASa7l
RIBED R DENTIAL PROPERTY. BACKFILL SEPTIC TANKSI�
SIGNATURE . SEEP.PIT(S)o CESSPOO LSTQ
OF PERMITTEE .... .... ......^........y......._.......
7UA642A U63 7/53