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Home My Public Portal About9031 BROADWAY_Sewer__ 'E808 6A642 10-63 APPLICATION FOR PERMIT : COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION OUILDI NG JOHN A, LAMBIE. County Engineer ADDRESS N o3 f� aL4?d4J WILLIAM A. JENSEN. Sup't of Building iii O�e eLl� LOCAL Y L NEAREvT FOR APPLICANT TO FILL IN CRDBG BT. ps¢y�2 4*d B- <K_ EGAL T: 4 o DESCRIPTION LOT 4 aOD O O OWNER e LO MAIL N/{ J d ' BLOCK TRACT / � , AD°RE55 / D ZGI�-A- (e,� A-V B DCS. �1 SIZE OF LOT NO ON LOT -J CITY EL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS CONTRACTOR ^^ B; _ PG ADDRESS UUy CONNECTION DATA CITY TEL. NO. STATION /3 71-13 ,-7 DEPTH STATE MANHOLE REFERENCE 1V UPPER COUNTY REGISTRATION NO. 1 _JI NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. } PUBLIC SEWER @ f5.00 /-3 - -) PC NO O SEPTIC TANK.SEEPAGE PIT OR JOB NO, PITS AND/OR DRAINFIELD f10.00 CO.IMP. NO. V PHO URIVATE DISP CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL TEMBLD X3.00 K CONNECT A°°ITIONgI BLDG.OR AFFIDAVIT [IV [[E[M[Ni flECORD.INSTR,NO. DATE Q WORK TO HOUSE SEWER f3.00 F U OVERFLOW BEOL.DR WELL. AINFIELO 0- ALTN..CESSPOOL.DRYWELL.MANHOLE� SS.00 D_ ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING y SEWER ON DISPOSAL SYSTEM ® 83.00 STATE ENCROACHMENT Z PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S1 21 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 1/V REIMBURSEMENT FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF-19— OWNER F 19_OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PITS) I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT q AGREE COMPLY WITH ALL COUNTY ORDINANCES AND STATEE LAWS REGULATING PLUMBING AND SEWERS, CESSPOOL ❑ DRYW ELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ..CP,PITIS) ❑ CESSPOOLS ❑ VALIDATIO ROBERT A. WOOD UPERVISING MECHANICAL ENGINEER CK. M.O. CASH L1Lo 5 9 0 1 IVDU 1 6 1 0 D 5.0 0" Y6AS420 APPLICATION FOR PERMIT 8 Q E.663 1199 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Dopaxtmont of County Engineer - County of LOU Angeles BUILDING e"') 3 / c Rt SOD U� ( JOHN A. LAMBIE.COUNTY ENGINEER ADDRESS V ® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT/JTO FILL IN CRO"ST.LEGAL OSclYlc.4� �1'/vo DESCRIPTION LOT NO. A-//� ' OWNERMAIL �oRll�Sn..w' BLOCKTRACT Di �dLor%9 ADDRESS SIZE OF LOT / NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP UK MAP BUILDINGS pe— PG CONTRACTOfl' ��u .H ji S:/C+I/IC.D/ J ADDRESSfir- / . CO ECTION DATA CITY C7 �r,�VTG TEL. NO. "� �7/1� 'STATION yEPTH MANHOLE REFERENCE ft UPPER STATE REGISTRATION NO. � Q / '��'/ Z ❑$Zemmyj I C�tA No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO � TYPE OF CONNE LENGTH FROM PUBLIC SEWER @ $3.50JV Y. CURB P.L M.L.TOP.L. SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR GRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,GRAINFIELD 1 P. C. NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. � (/ JOB NO. HOUSE SEWER CONNECTING TO �t lJ 'PRIVATE DISPOSAL SYSTEM @ $L00 TRUNK PERMIT N0. ROAD PERMIT N0. /alto / CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 0 PERMIT NO. ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL _ SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 8 1 00 AUTHORIZATION- TOTAL FEE SC REIMBURSEMENT FEE (c 1 HAVE AT.THIS DATE A CONTRACT WITH THE HEREIN NAMED con- APPROVALS DATE INSPECTORSSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEpW/ER.- ,�e /�J NEW HOUSE SEWER SIGNED THIS v D Y OF ~'e" 19.1(1. -CONNECT ADDITIONAL OWNER ORf�Y�.=�c"-. BUILDING OR WORK - �- OWNERS AGEN SEPTIC TANK,SEEP,PIT(S) - AOOR ESS �(.�� AND/OR GRAINFIELD I HEREBY ACKNOWLEDGE HAT I HAVE READ THIS. PLICATION CESSPOOL❑ DRYWELL❑ M1NO STATE THAT THE ABOVE IS CORRECT AND AGR TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I 'CERTIFY THAT 1 AM PROPERLY REGISTERED AN SCCT PL OR �, DIONNEUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY 011 BT OF ABANDON HOUSE SEWER CALIFORNIA 0 T 1 M TH L{GAL OWNER THE ABOVE 44 CALIFORNIA DESCRIBED RE IDEN AL ROPEIRR/LryFFF,,,/ BACKFILL SEPTIC TANKS SIGNATURE // �' `j/� SEEP. PIT(S) O CESSPOOLS❑ OF PERMITTEE •'( VVV / JOHN A. LAN BIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR 1(f C.- 2 S ISH2 °, JUN 2 4 A _ 6.50 N.