HomeMy Public PortalAbout9063 - 9069 BROADWAY_Sewer__ DEPARTMENT OF COUNYY M443EVEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
GUILD NO
WILLIAM J. FOX, COUNTY ENGINEER I ADOR ESS
FOR APPLICANT TO FILL IN . LOCALITY 7�c:f .
BUILDING NEAREST /
ADDRESS i CROSS ST. e,Apoe &lnl
LOCALITY n717 ci DISTRICT N0. SERIAL N0. PEflMI -13S 0.
VIA
NEAREST o—�r� Z /��/ / S A `/f`, 3 S
CROSS ST. //� //,tsf`/ / E EIVE Y RceAy for Inspection DATE/,ISSUED
OWNER �'y' /�"i�`�' /.f /2 ��`��
AI L
ODBEESS�'Ly� //J7 /.[]/T/(gNysJ./ USEZONE P_ A /��OjCCUPANCY BK MAP/P'7G
CITY'v_zlw_.I.I/Iy •. sTEL.NO. +� L /
CONTRACTOR •� - Y CO.IMP.NO. 7 Z
I ' JOB.NO.
CITY d4, p� TELNO.^770 'l17 7 Y TRUNK PERMIT NO.STATE
'
REGISTRATION N0. / v7 C C`, ' ❑ COUNTYf �/nn
ROAD PERMIT N0.
LEGL
DESCRAPTION LOT NO.��� �Ie�C 75o�w 197-4 PERMIT
ENCROA NT ,
_ _ PERMIT NO.
BLOCK TRACTS AlJAT,. + INDUSTRIAL
Y WASTE APPROVAL
SIZE OF LOT 7 _7 /� `ftj NOW BN LOTS CHARGES
USEOF
t. _ ' p I ,.
BUIIDiNG CONNECT CHARGE FEE
NO. DESCRIPTION OF WOR ,FEE REIMBURSEMENT /
7�. P UBLC USE SSEWEREWER NG TO @ 11 3.50 RECEIPT NO. DATES IBY '
HOUSE SEWER CONNECTING TO
. PRIVATE DISPOSAL SYSTEM 1.00 _
_ CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED`
WORK TO HOUSE SEW1.00 '
ALTER OR REPAIR EXISTING
NO
TING ( ' I GATE 18Y\
.
SEWER OR DISPOSAL SYSTEM I.00
DISCONNECT AND
_ AND/OR DISPOSAL SYSTEMN SEWER 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD I 2.00- STATION Y -1_� _ DEPTH (�
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY _ 2.00O NHOLE REFERENCE
e t HOPES: LOWER
TYPE OF CONNECTI LENGTH FROM
OWNERS PERMIT $ I OD Y. CURB P.L. M.L.TO P.L:
AUTHORIZATION I TOTAL FEE I 4 s'c
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPE TOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..... ..DAY I95'� NEW HOUSE SEWER
OWNER OR ` CONNECT ADDITIONAL
.OWNERS AGENT. __L___ r. SEPTIC NGORWORK
(lv_ ...0 .._.._.._.._.._.._. 4
r __..._
- /' 7 `O AAI___ SEPTIC TANK.SEEP.FIEL PITS)
•ADDfl ESS.:7..O.�.{._. .._ ... �....__.._._..._._._�.L.._�i._....._._. AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ 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 SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY, THAT 1 AM PROPERLY REGISTERED
ANO/OR LICENSEDQUIRED BY LOS AN S COUNTY ABANDON
AND STATE OFC RNIA OR THAT I AM T EG Ah OWN-' ABANDON HOUSE.SEWER
ER OF THE ABO DESCRIBED RESIDENTIAL OPERTY. BACKFI LL SEPTI C TANKS
SIGNATURE Q , SEEP.PIT(S)E].CESSPOOLS ,,,_,,,,. I his
OFPERMITTEE........................ . .._----------_-----....._............_i �
76A642A G63 7/53 �,
</T2
75A642L APPLICATION FOR PERMIT
]BAfi4X063 -6S -6/
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,
LEGAL
DESCRIPTION LOT NO. wOWNER < Cc
f0 MAIL -
o
BLOCK TRACT4t(J�4)V�(A� ADDRESS C )U
O. OF BLDGS.
SI2E OF LOT NOW ON LOT CIT TEL. NO.,;)S3 - aO I
USE OF
BUILDINGS DISTRICT N0. GROUP MAP CESSED BV
B/K PO
CONTRACTOR
ADDRESS A Lj VV CONNECTION DATA
CITY TEL. NO. y X71 STATION G�t� DEPTH
J e
LICENSE NO. �• CL SS MA E fRE CE ��• LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CON TION LENGTH FROM 3_:5J
HOUSE 5EWER CONNECTING TO Y. RB P.L. M.L.TO P.L.
PUBLIC SEWER ® p,C.NO. OL
SEPTIC TANK,SEEPAGE PIT OR /37'2- JOB NO, O
PITS ANO/OR GCO.IMP. NO.
RAINFIELD
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V
PRIVATE DISPOSAL SYSTEM
CONNECT AOOITIONALBLOC. •L.0 AFFIDAVIT AME[• V3[Y(X� RECORD.INSTR.NO. DATE O
l��JETO HOUSE SEWER ® J 1-
OVERFLOW
OVERFLOW SEEPAGE PIT.DRAINFIELD U
EXTN..CESSPOOL.DRY,WELL,MA..O LE
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING .04- N
SEWER OR DISPOSAL SYSTEM STATE ENCROACHMENT
PERMIT NO. r
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT s S� CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
ITHAVE AT THIS DATE A CONTRACT WIH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'551GNATURE
SIGNED THIS .._DAY OF 19�
OWNER OR ` NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL 7- V-7,7 �
ADDRESS BUILDING OR WORK y
HEREBY ACKNOWLEDGE THAT SEPTIC TANK.SEEP.PIT(S)HAVE READ iH15 APPLICATION AND/OR DRAINFIELD
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR
LICENSEDAS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG PNO
RESIDE IN, THE ABOVE OESCHIBE RESIDENTIAL P Y.
. ABANDON HOUSE SEWER
SIGNATURE
OF PERMR TBACKFILLSEPTIC TANKS ElSEEP.PIT 151 ❑ CESSPOOLS ❑
VALIDATION
CK. M.O, CASH
0 7 2 MAY 3 1 0 0 1 3.5 0 A9'