HomeMy Public PortalAbout9055 BROADWAY_Sewer__ y
"Es 312.5. APPLICATIOIi9 FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Loa Angeles BUILDING
SS_ =BroadwayWM. J. FOX. COUNTY ENGINEERCASSATT D. GRIFFIN. SUPT OF BUILDING -- LOCALITYFOR APPLICANT TO FILL IN ceossST. dwayLEGAL �/ ) / CCDESCRIPTION LOT N0. '�/•/ B ✓ CO' OWNER BLOCK TRACT 1,A6MAIL
ADDRESS
/ 1 NO F BLOGS.SIZE OF LOT_�J ���QO NO ON LOT CITY
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK
CONTRACTOR Standard Plumbing ComAan}* ,j I �Q.,d_ [,/ P'�
ADDRESS 4333 E. Florence Ave. CONNECTION DATA
CITY Bell, TEL. NO. JE 1124 STATION ID -yL `,7. 0 DEPTH 6
C36 39243 ❑ STATE / Q 1 I MANHOLE REFERENCE
3
REGISTRATION NO. , [1 COUNTY L COUNTY �Ip /� W
s'-� TYPE OF CONNECTION LENGTH FROM
NO. I DESCRIPTION OF WORK FEE K: CURB .-e[. M.L. To
P.L.
1�7
1 HOUSE SEWER SEV/ERCONNECTING TO
PUBLIC CD S 3.50 3 .50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG, OR CO. IMP. N0. 7 JOB. N0.
WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING
ALTER OR DISPOSAL AL SYSTEM 1.00 TRUNK PERMIT N0. ROpo PERMIT N0. O{ 11
DISCONNECT ANO 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 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FEE 4 50 REIMBURSEMENT FEE
I HAVE DATECON-
TRACTORTHIS TO CONNE TO THE AABOVE DESCR BEDWITH THEH EREIN EXISTINGAMED DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER •-
NEW HOUSE SEWER / 1.
SIGNED THIS pAY OF - 19
OWNER OR'
CONNECT ADDITIONAL
WORK
OWNERS AGENT W BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS •AND/OR DRAINFIELD
1 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
PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR
I HPE
EREBY CERTIFY THAT I AM PROPERLY REGISTSEWAGE DISPOSAL SYSTEM
ERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIREO BY LOS ANGELES COUNTY AND STATE OF ABANDON HO USE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑Z •l�;`S I (,� /I �1 =T❑
l SEEP. PIT(,) ❑ CES
SPOOL51]
SIGNATURE '•
OF PERMITTEE
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION
*_:�3 6 1 i n MY 11 4 4.55 O n
BY BY
DEPUTY DEPUTY
BY BYw+�Y/•^'�C/ /�
® DEPUTY d DEPUTY