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Home My Public Portal About9070 BROADWAY_Sewer__ IDEPAIVCMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 4 -; DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS V*l 'Rt-c)mcI\LuEbl. F R APPLICANT TO FILL F�IIL2L INLOCALITY - LOCALITY ADDRESS D �D e• Aee46 `7 CROSNEAIS ST. _ a LOCALITYii DISTRICT NO. SERIAL NO. PERMIT NO. Rrfdl� �t rETi A S _S NEAREST CROSSST. fi0� _{I L(/Q �ECEIVED BY Reetly for Inspection DATE 3UEf1 OWNERMAIL �I��/� R•/Y J��r(.�Prlr/^ 1'tB.PG I Z�3�fJ 3 ADDRESS 9(/yQ �~ /.YL�'�(,/�/yeC/ USE ZONE' OCCUPANCY BK MAP`P CIT Gf LI�YEL.NO. 1 L� I CONTRACTOR Q .( CO.IMP. NO. ADDRESL?*L oG /i'=�G� JOB NO. CITY Y 4{{�,�Q�I/ TELAOO./.D4 7 j/I d' TRUNK PERMIT NO. REGISTRATION N0. //� 4Gjf/� ff-rrAT COU NTV ROAD PERMIT NO. 2� /C? LEGAL DESCRIPTION STATE ENCROACHMENT LOT N0. PERMIT NO. BLOCK TRACT ��' �� INDUSTRIAL NO.OF BLDGS. WASTE APPROVAL SIZE OF LOT 106A-,1411- NOW ON LOT / CHARGES USE �� / ...1� BUILDINGS ILL /(/ CONNEC QV`CHARGE FEE / NO. DESCRIPTION OF WORK FEE �1 REIMBURSEMENT FE6� / HOUSE SEWER CONNECTING TO ® = 3.50 .� V HOUSE RECEIPT NO. / xA\ IBY I PRIVA SEWER CONNECTING TO r PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDE\ WO RK TO HOUSE SEWER - IAO — ALTER OR EXISTING REPAIR / NO. I DATE IBY\ SEWER OR DISPOSALSYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR ^ PITS AND/OR IELD 2.00 STATION 4 Q L 1 3 DEPTH CESSPOOL—DRYW RYWELELL SPECIAL CONDITIONS ONLY 2.00 102,Cl I (MANHOLE REFERENCE YlRBSH• -L'DWER TXPE OE.GOlJNECTION LENGTH FROM 1 'Yj ( CURB>'1 XPi{.:,,. M.L.TO P.L. OWNERS PERMIT $ I 00 AUTHORIZATION TOTAL FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO LHE PUBLIC SEWER, SIGNED THIS---...............DAY OF ............. 19,5 NEW HOUSE SEWER Govx!!Lx• YL-1�3 OWNER OR ./ yp.�. CONNECT ADDITIONAL 7 /I.ef/d.uq _ BUILDINGORWORK OWNERS ACENT....Ct._�F'.ti.ICYL�...._:.._.._.._.....�......_. ADDRESS...... . AND/OR GRAINFIELD PIT(S) . 5.24--. ._:.L.Y�w.rn.—'a'•!L"�:+--�.........._... I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DI SCONNECT PLUG AND ANO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CAL FORNIA OR THAT 1 AM THE LEGAL OWN• ARAN DON HOUSE SEWER ER OF THE ABOV DESCRIB RE DENTIAL PRQPERTY. BACKFILL SEPTIC TANKS E I SEEP.PIT(S)E] CESSPOOLS Q ,u, �� Z� (j '�-•3• SIGNATURE , OF PERMITTEE..._......._.._.._.........._...._..... 76A642A 663 7/553 �� 6A64 10-63 20 APPLICATION FOR PERM[ C BOB COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �� y JOHN A. LAMBIE, County Engineor ADOREss !�' WILLIAM A. JENSEN, Supt of Building E TY NEAR NEPREuT FOR APPLICANT TO FILL IN `ROSS ST. LEGAL KY'--'I / A _ if DESCRIPTION LOT NO. OWNER DC U 41 MAIL BLOCK TRACT `J�f/1 ADDRESS �� y NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO, USE OF DISTRICT NO. GROUP I MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR /� r — ��FFF ADDRESSj.. CONNECTION DATA CITY T.L. NO, r12 ka&l STATION DEPTH STATE UPPER REGISTRATION NO. 1 COUNTY MANHOLE REFERENCE LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. CIL PUBLIC SEWER @ 55.00 P.C.NO. O SEPTIC TANK,SEEPAGE PIT OR CO. IMP.NO. JOB NO. U PITS AND/OR DRAINFIELD 510.00 1 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.P R VATS DISPOSAL SYSTEM ® S3.00 O CONNECT ADDITIONAL AFFIDAVIT An IA [I.IT RECORD. NSTR.NO] DATE F / WORK TO HOUSE SEW ER ® S3.00 �_�_ U OVERFLOW SEEPAGE PIT.DRAINFIELD W E%TN_CESSPOOL DRYWELL.MANHOLE 0 $5.00 1 WIDENING N ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST. SEWER OR DISPOSAL SYSTEM ® S3.00 STATE ENCROACHMENT PERMIT NO. ) _ INDUSTRIAL WASTE APPROVAL ` CHARGES OWNERS PERMIT s z o0 AUTHORIZATION TOTAL FEE CONNECTION CH4RGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR 'B SIGNATUflE SIGNED THIS DAY OF 19_ , f OWNER OR NEW HOUSE SEWERI Y OW NERSAGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT 151 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCEE S AND $TgTE LAWS REE GULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYW 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 AM THE LEGAL OWNS OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABO DES IBED SIDEN L PROPERTY. ABANDON HOUSE SEWER SIGNATURE N BACKFILL SEPTIC TANKS ❑ OF PERMITT ❑ SEEP.PIT ISI ❑ CESSPOOLS VALIDATION ROBERT A. WOOD CK. M.D, cgSH SUPERVISING MECHANICAL ENGINEER L1. 9UGoo ;:,iY2111 0 D 5.00-'