HomeMy Public PortalAbout9159 BROADWAY_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY I PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER BUILDING
ADDRESS _
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FOR APPLICANTLOCALITY
TO FILL IN
ADDRESS- 9 ✓ 7 F l�w'I/ I CROSSST.
LOCALITY DISTRICT N0. SERIAL N0. PERMIT N0.
"RAREST. s A ) 32 B / Mg-3 9 S
RECEInVE0,6Y Ready for lnapeotlpn DA� SSUED
OWNER Q�Q�H.J JlY/7,�/jJCI _/(/,[G�
ADDRMAI LESS ✓ I, USE ZONE OCCUPANCY BK MAP PG
CITY ,� T i.NO. '6
CONTRACTOR / ^
CO.IMP. N0. 71 —"1 ,4
ADDRES JOB,NO.
CITY TEL.NO. TRUNK PERMIT NO.
REGISTRATID NO. .N
/ B STATE
LEGAL COUNTY ROAD PERMIT NO. 8
/
DESCRIPTION LOT NO. STATE ENCROACHMENT
I /I-M-FJl..� PERMIT NO.
BLOCK TRACT - - INDUSTRIALS- - -. - --_
NOW ON LOT WASTE APPROVAL CHARGES
"'y 4 / N0.OF BLOCS.
SIZE OF LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE .
HOUSE SEWER CONNECTING TO
I PUBLICSEWER - S� 3.50 D RECEIPT NO. I DATE IBY
HOUSE SEWER CONNECTING TO
P RIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER NO OR REPAIR EXISTING - I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR Q a
PITS AND/OR GRAINFIELD 2.00 I STATION DEPTH
SPECIALCONDITIONS ONLY 2.0024
/ MANHO LE ERREFERENCE �^ /
. rl-- G, �JJ'1 Lt1 RRF
TYPE OF CONNECTION LENGTH FROM
CURB P.L— M.L.TO P.L.
OWNERS PERMIT $ I I 00
AUTHORIZATION . TOTAL FEE ¢ ,t
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE
777 PUBLIC SEWER
SIGNED THIS.//... DAYeOF.K74-4,�--_�_42 NEW HOUSE SEWER r ,J,L ^ („2e
r .
CONNECT ADDITIONAL '
OWNER OR BUILDING OR WORK
OWNERS AGENT--- ..----._r.. __.._...._...._._..._�'�^! 1 SEPTIC TANK,SEEP.PIT(S)
ADDRESS_.........___------_---------------_------:------...................................... AND/OR GRAINFIELD ..
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Q DRYWELL El
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 IAM PROPERLY REGISTERED I -
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[I CESSPOOLS
OF PERMITTEE----------------._......._._.........._.._....__.................._...._..
54
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