HomeMy Public PortalAbout9076 BROADWAY_Sewer__ DEPARTMENT of COUNTY ENGINEER-':;,., SEVER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES.
WILLIAM J. FOX: CODNTY`ENBINEER _�I BUILDINGADDRESS _90,70 -,f .O'/rt�ikp�Lv�Ji
FAIL
R APPLICANT .FILL .14 "I LOCALITY 7w(F CiTy
aI�/ I NEAREST CROSS ST.- SU ��DISTRICT N0. SERIAL NO. PEERMIT NNs,O.
`, / A A37/ e9(/ RECEIVED BY Reatly for Inspection DATEISSUED
- /U�SEZONE OCCUPANCY MAP '
ADDRESS z RK PG
CITU TELN Y�.It
CONTRACTOR 4 CO.IMP.NO. /3 72- _4
ADDRESS JOB.N0. ��•�•
CITY �7 TEL/N(O.A TRUNK PERMIT NO. —dam
REGISTRATION NO.
/"/D�/�❑ COUNTY ROAD PERMIT-NO.
LEGAL STATE ENCROACHMENT
i DESCRIPTION LOT NO. Q ) �j PERMIT NO.
• BLOCK TRACT ~ MQ ZU� T/-7EC INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT46-14 N0.OF BLOCS.
NOW ON LOT CHARGES
USE OF /
BUILDINGS i Q CONNECT CHARGE FEE
NO. DESCRIPTION OF Aqfft FEE REIMBURSEMENT
HOUSE SEWER CONNECTI
PUBLIC SEWER .. ' ® S 3.50 O RECEIPT NO. I DATE— I BY
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED.,`\
WORK TO HOUSE SEWER' 1.00 -
SE ER OR REPAIR EXISTING NO' DATE (BV�
SEWER OR DISPOSALEXISTING
SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/ORDISPOSAL SYSTEM 1.00 QQ CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR p'� g-: DEPTH
PITS AND/OR GRAINFIELD 2ASTATION 0 I -
SESSPOOL—DRYWELL
PECIAL CONDITIONS ONLY 2.00 S 2'J MANHOLEEREFERENCEUppuLOWER
OWNERS PERMIT $ I 1 00
TYPE OF CONN EeTwa LENGTH FROM
Y. cuRe ✓ P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE SD
I HAVE .THIS DATE CONTRACTED.WITH. THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER - . o.
-
SIGNED THIS....-Z.9- OF____ +_ ___19�v NEW HOUSE SEWER ZR S,
//��/ CONNECT ADDITIONAL
OWNER OR �� / l BUILDING OR WORK `
OWNERS AGENT. ..-. ._.... .... _ ,
di ---�t }y� SEPTIC TANK.SEEP.PIT(S)
ADDRESS ...lZ_�___T'..�._.. ._..ve ,.y. %� _i_- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT IHAVE�READ THIS APPLI• CESSPOOL DRVW ELL
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 DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESEW ER
AND STATE OF CALIFORNIA OR THAT I AM TIE LEGAL OWN.
ER OF THE ABOVE D RIBED RESID NTIAL PROPERTY. BACKFILL SEPTIC TANKS El
SIGNATURE SEEP.PIT(S)Q CESSPOOLS
OF PERMITTE .s �..._
7GA64LA 663 7/03 '