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Home My Public Portal About9123 BROADWAY_Sewer__ ` *6$a" °°2D .-• ISaA APPLICATION FOR PERMI� �1g1I ' " . COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL u DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION eulLw Nc ,JOHN A. LAMBIE, COUNTY ENGINEER ADORES. C• COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT,NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLDOW SIZE OF LOT NOW ON LOT. I CITY TEL. NO. USE OF I DISTRICT NO. GROUP MAP PROCESSED BY BUILDING. RBK PG CONTRACTOR lWZWlI5'-0AZ FU .(/ / 7 ADDRESS / .•••((((//// CONNECTION DATA CITY TSI. NO. _ STATION DEPTH STATE LIC q - UPPER LICENSE NO. 1q / C CLAS G vJ MANHOLE REFERENCE LOWER NO. DESCRIPTION OP WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER E .BF SEPTIC TANK.SEEPAGE PIT OR P.C.NO. PITS AND/OR GRAINFIELD EIO.00 CO. IMP. NO, JOB NO. HOU5ESEWER C ONNECTING TO TRUNK PERMIT NO. ROAD PERMIT ryO, d PRIVATE DISPOSAL SYSTEM E..GO O CONNECT ADDITIONAL R aO gFFIOA V IT Alv s[n[ RECORD. INSTq.NO. DATE V WORK TO ROUSE SEWER E3.00 CC OVERFLOW SEEPAGE PIT,GRAINFIELD Q EXTN..CESSPOOLDRYWELL,MANHOLE® 35.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING V SEWER OR DISPOSAL SYSTEM ® E3.00 W STA TE ENCROACHMENT �� d PERMIT NO. GO INDUSTRIAL WASTE APPROVAL _ y CHARGES OWNER'S PERMIT s Go AUTHORIZATION TOTAL FEE } Uo CONNECTION CHARGE FEE IHAVE 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 INSIPECTOR'S SIG NATO RE SIGNED THIS DAV OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL I ADDRESS BUILDING ORR WORK SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT.1 HAVE READ THIS APPLICATION AND/OR DRA NFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS, CESSPOOL ❑ DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY L05 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TODISCONNECT PLUG RESIDE IN, THE ABOVE D CRISED RESIDENTIAL PROPERTY, ABANDON HOUSE AND G AAND SIGNATUREER OFPER BACKFILL SEPTIC TANKS ❑ OF ERMRTEE / SEEP.PIT ISI [I CESSPOOLS ❑ /1V)RL ION JACK R. ALLEN (:CK/. / CASH SUPERVISING MECHANICAL ENGINEER L r � n V I, HAA2 2 1 I:) D 6.0 0 0311.551_ APPLICATION FOR PERM'� . DIVISION OF BUILDING AND SAFETY. SEWER—SEWAGE DISPO AL I Deportment of County Engineer - - - , IdIZz County of Los Angeles BUILDING 9is ADDRESS 9 U JOHN A. LAMBIE, COUNTY ENGINEER ® CASSATT D.GRIFFIN, SUF'i OF BUILDING LOCALITY F R PP T C / —CROSS sr. OESCRI PTION LOT NO. 17 �r ,JO/L GY�H A�(� . OWNER /�f1r, ,, BLOCK - TFACTS'�yAr�/y t/'27.� AD0RE55 %�� ,� p�2o�lwRV�/L/�T� N0. O BLDGS. CITY F G TEL. NO. SIZE OF LOT NOW ON LOT USE OF DISTRICT N0. GROUP MAP , PG BUILDINGS CONTRACTOR SO A,�A✓/1. // /LL/A// (.� 1-3 . D(/ l-' ADDRESS71 7 TYII+_,[�r „wp'/�'/ul--F L5i! O //]CONNEEF�ION DATA /" ♦ DEPTH S 6,6,CITY pw TEL. N0. S �� I MAN HONE REFERENCE J LOWER REGISTRATION NO. /�d 6 90 ❑ COUNTY _ No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $300 3 Y. CURB P.L. M.L.TO P.L. 7 1 SEPTIC.TANK,SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD Q $3.00OVRLOW SEEPAGE PIT,D EXENF,CESSPOOL,DRYWELLRM AN HIOLE Q ELD $2.00 CO. IMP. NO. /J /� '}OLJOB N0o SEWER CONNECTING TO PRIVATE Q / / PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT N0. ROAD PERMIT NO. /G CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER ® $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM « $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 8 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTORSSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 10 THE PUBLIC SEWER, NEW HOUSE SEWER ._ L D THIS DAY OF 19 CONNECT ADDITIONAL R OR BUILDING OR WORK RS AGENT SEPTIC TANK,SEEP, PIT(S) SS AND/OR DRAINFIELD EREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIONCESSPOOL❑ pftYWELL❑ TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY"ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR BING AND SEWERS. SEWAGE DISPOSAL SYSTEM EREBY CERiI FY THAT I AM PROPERLY REGISTERED ANp/ORpSCONNECT PLUG AND SED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF pBANOON HOVSE SEWER ORNIA OR THAT I qM TME LEGAL 04YNER OF THE ABOVEIBED RESIDE I PROP TY. BACKFILL SEPTIC TANKS❑TURE SEEP.PITS) ❑ CESSPOOLS❑ERMITTEE JOHN A. LAMBIE. COUNTY ENGINEER /—VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR cR. N, D. 1ASH ;.f L_c6 3 p 5.r. %ep - E68 APPLICATION FOR PERMIT e6DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer - - - County.oi Los Angeles BUIL JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS la ® CASSATT D.GRIFFIN. SUPT OF BUILDING LOCALITY " // 7 FOR APPLICANT TO FILL IN CROSS ST. 'f'LdP�� LEGAL /J / OWNER DESCRIPTION LOT NO. �/ �-( CTYf ,�-[.� BLOCK TRACT �J �c],�, � _- J MAIL ^`"4t�4�4U-� ADDRESS NO. OF LOGS. SIZE OF LOT G IorX IPI NOW ON LOT Z. CITY TEL. NO. n UBE OF BUILOINGS DISTRICT NO. GROUP MAP . j C BK PG ` CONTRACTOR CONNECTION DATA pODRE55 � , CITY T 7 1 STATION DEPTH C �.. E N0. MANHOLE REFERENCE9 p dr p� _ UPP�PER REGISTRATION NO. EY STATE V T❑ counrY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION�� LENGTH FROM 7 O PUBLIC SEWER @ $3.50 Y. CURB /r.�,i M.L.TO P.L, c� SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR GRAINFIELD E 3.00 OVERFLOW SEEPAGE PIT. GRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @1 $ 2.00 CO. IMP. N0. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 _TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER Q $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM tsi g L00 WASTE APPROVAL - CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN LAMED CON. - _ APPROVALS DATE INSPECTOR'S SIGNATURE HAVE TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS DAY OF JAND/OR CONNECT ADDITIONAL OWNER OR �1 ABUILDING OR WORK OWNERS AGENT �. _e_< ' �ISEPTIC TANK,SEEP,PIT($) ADDRESS AND/OR GRAINFIELD IHEREBYACKNOWLEDGE THAT 1 HAVE READ THIION CESSPOOL❑ DRYWELL❑AND STATE THAT THE ABOVE ISCORRECT ANO AGRPLYWITH ALL COUNTY ORDINANCES AND STATE LAWING ALTER.REPAIR,SEWER OR PLUMBING ANO SEWERS. SEWAGE DISPOSAL SYSTEM1HEREBY CERTIFY THAT I AM PROPERLY REGISOR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AFI THE LEGAL OWNER VEDESCRIBED RESIDENTIAL PROPERTY. ` BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP. PITT S) ❑ CESSPOOLS❑ OF PERMITTEE JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR 53 4Av4.5 0 In p /► q p� ® I�p(� t� 1 >aAa.ac APPLICATION FOR PERMIT r e�aaDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer CoI=ty of Los Angeles BUILDING WM.J. FOX, COUNTY ENGINEER .ADDfl E55 3 .G _.D�CL�A CASSATT D. GRIFFIN, SUPT OF lWLo1N0 tLOCALTTY FOR APPLICANT TO L I ICFosssT. OE PAP— LEGAL DESCRIPTION LOT NO. a 'OWNER .g¢ BLOCK TRACT ADDRESS 'ADDRESS SIZE OF LOT /�/ p N0. OF LDGS. CITY �.7 NOW ON LOT " TEL. N0. BBE DI &OILA C� DISTRICT NO. ROUP MAP BUILDINGS E./ CONTRACTOR /'/TX ��iL/ �j O�PPG ADDRESS �Y/� ,5� 1 P/L� CONNECTION DATA (� CITY / J�j'� TEf. NO. STATION 2:fpSt Q DEPTH v �/ [�SfATE MANHOLE REFERENCE OL44 o UPPER REGISTRATION NO. J ❑ COUNTY - NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECT - LENG H FROM PUBLIC SEWER Q S 3.50 O Y. CURB P' M.L. TO P.L. HOUSE SEWER CONNECTING TO tVt ® 4 PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR G"8 SCO. IMP. N0. JO'NO YORK TO HOUSE SEWER 1.00 _ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 (TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR GRAINFIELD 2.00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES PERMIT CONNECTION CHARGE FEE ' OWNER'S 5 1 00 AUTHORIZATION TOTAL FEE /f REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORSSIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ NEW HOUSE SEWER qr OWNER OR � R/IO//_^ CONNECT ADDITIONAL OWNERS AGENT v w— BUILDING D WORK SEPTIC TANK.SEEP. PIT(S) ADDRESS AND/OR GRAINFIELD 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 ALTER, REPAIR.SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR )' LICENSED AS REQUIRED BY LOS A14GELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP. PIT(SI ❑ CESSPOOLS SIGNATURE `( OF PERMITTEE WILLIAM J. FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLUG. INSPECTOR LAr 5 O 1 2 w APR 11 4 5.5 Q ✓A: