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Home My Public Portal About9226 BROADWAY_Sewer__ zo _ -63. '. ` T AG ` -APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7DR " / JOHN A. LAMBIE. County Engineer ppbWILLIAM A. JENSEN, Supt of Building FOR APPLICANT TO)FILL•IN "[LEGAL f.[ //gyDESCRIPTION �/� m/� �(/BLOCK TRACT �' L NO. OF BLDGS. SIZE OF L NOW ON LOT CITY _ TEL. NO. USE OF I DISTfl ICT NO. GROUP MAP TINBUILDINGS CONTRACTOR �' l �//i. 7GADDRESS yt�r r . ytM�J( CONNECTION DAT r CITY j,�Cl. T05J e �"+!y 7 STATION J i -LJ STATE Z C DEPTH rJ REGISTRATION NO. ryG(/pf"� GL///� �❑ COUNTY (MANHOLE RECFJERENCE (•J LOWER NO DESCRIPTION OF WORK FEE TYPE OF CO N N v LENGTH FROM HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. } PUBLIC SEWER @ $5.00 �� d P.C.NO. O SEPTIC TANK.SEEPAGE PIT OR CO.I.P.NO. JOB No.PITS ANO/OR GRAINFIELD $10.00 CJ HOU BE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM ® 53.00 !�1' CONNECT ADDITIONAL BLDG.OR AFFIDAVIT ry s[x[xi RECORD.INSTR.NO. DATE 0 WORK TO HOUSE SEWER ® 53.00 V OVERFLOW SEEPAGE PIT.GRAINFIELD 1 W E%TN..CESSPOOL.ORYWELL.MANHOLE® SS.00 d STATE ALTER.REPAIR 0R ABANDON HOUSE HWY.OR IDENI G h SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT Z PERMIT NO. INDUSTRIAL i WASTE wPPgOVAL CHARGES OWNERS PERMIT 5 dDWELLING CONNECTION.CHARGE FEE AUTIiORIZATION TOTAI. Fee '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAREIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED E) STING TO THE PUBLICSEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF OWNERORn NEW HOUSE SEWER OWNERS AGENT Fi CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY C T THAT I AM PROPERLY REGI TERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS OUI D BY L05 PNQLES COUNTY"BACKFILL EWAGE DISPOSAL SYSTEM CALIFORNIA R THA AM THE LL OWN OF RESIDE IN. HE VE DESCRIBE R SIG. IA PRISCONNECT PLUG ANO / BANDON HOUSE SEW ER SIGNATURE - OF PEPMITTEE SEPTIC TANKSEEP,PITIS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.0. SUPERVISING MECHANICAL ENGINEER CASH �f00303� APR 610 0 7.00 [° • � C ' CEB083-64 76A642D APPLICATION FOR ERMIT / ' �' COUNTY OF LOS ANGELES / DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUII.DINc !! JJ JOHN A. LAMBIE, County Engineer ApoRess z ZEA G� /J�Of�D:6/9 WILLIAM A. JENSEN, Sup't of Building LOCALITY N.A. FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. p pp �T 3 OWNER P6 DO�'� MAIL A BLOCK TRACT 9 ADDRESS ZCRQ fJ(VR NO. OF BLOCS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS � BK PG CONTRACTOR 4 .a ADDRESS - 10 CONNECTI N DATA • STATION DEPTH CITY TEL. NO. F}qI STATE MANHOLE REFERENCE REGISTRATION NO. LJ COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO.P.L. "L"C SEWER ® $3.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS ANO/OR GRAINFIELD ® $10.00 CO.IMP.NO, JOB NO. 0 O HOUSE I POSAL NESTING TO TRVNK PERMITN ROAD PERMIT NO U PRIVATE DISPOSAL SYSTEM ® 33.00 CONNECT HOUSE SEALSLpG.OR AFFIDAVIT us[s[xi RECORD. INST O. DATE O WORK TO HOUSE SEWER � $3.00 OVERFLOW SEEPAGE PIT,DRAINFiELD E%TN.,CESSPOOL,ORYWELL,MANH O LE® 33.00 U ALTER.REPAI III OR ABANpON HOUSE HWY.QRST,WIDENING $EWER O DI ORAL SYSTEM E3.Do Z STATE ENCROACHMENT PERMIT NO. _ �. INDUSTRIAL WASTE APPROVAL OWNERS - PERMIT $ 2 00 CHA ES AUTHORIZATION TOTAL FEE CONNECTION ARSE FEE 'IHAVE AT THIS DATE A CONTRACT WITHITNE HEREIN NAMED CONK REIMB SEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EX15YING DWELLING TO THE PUBLIC SEWER. - APPROVALS DATE - INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ - OWNEROR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) 1 HEREBY ACKNOWLEpGE THAT IHAVE HEAD THIS APPLICATION .AND/OR DRAINFIELD AND STATE THAT THE ABOVE I5 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑. ORYWELL ❑ I HEREBY CERTIFY THpT M PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR LICENSED A5 RED IRED L ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM'. CALIFORNIA OR THAT AM TH LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE AB E.OES I D RESIDENTIA PROPERTY. ABANDON No USESEWER .SIGNATURE BACKFILL SEPTIC TANKS OF PERMITTEEl SEEP,PIT(9) ❑ CESSPOOLS VALIDATIO�I� `} ROBERT WOOD cK, M.o. LD SUPERVISING ENGINEER ! .1'- 8 3"1 41t 2 'nrn24 1 0 0 5.0'0 Q C E80AG48 1 10-63 • • APPLICATI N FOR PERM T C COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING C JOHN A. LAMBIE, County Engineer AODR Ess 7 _ WILLIAM A. JENSEN. Supt of Building —v LOCALITY NE4RE^vT FOR APPLICANT TO FILL IN CR°SSG G LEGAL 1 / �yJ� DESCRIPTION LOT N[O J�,� n"�� OWNER //l / (C��'' BLOCK TRACT MAIL � ADpRESG VC ,I NO. OF BLOGS. SIZE OF LOT NOW ON LOT CITY �� TEL. NO. USE OF —^ ^ DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS IU.JI 9 k TOR BK / G•� / C�i > •CONNECTION DATA ST/TION /i ..PTH STATE MANHOLE REFERENCE q,/ A TION NO. OOUNTY 7 /' / LOWER DESCRIPTION OF WORK FEE TYPE OF CONNEC � N LENGTH FROM MOUSE SEWER CONNECTING TO Y. C_ B P'L. M.L.TO P.L. f � a PUBLIC SEWER @ 55.00 SEPTIC TANK.BEEPAGE PIT OR P.C.NO. O PITS AND/OR GRAINFIELD 510.00 CO. IMP. NO. 15V JOB NO. v HOUSE SEWER CONNECTING TO - TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 / V ^ CONNECTADDITIONALBLOG.OR AFFIDAVIT WAIVER [ SEM[ RECORD.INSTR-NO. DATE VF WORK TO USE SEWER ® 53.00 v E.T E SEEPAGE PIT,GRAINFIELD E%T .CGSPOOL.DRYWELL.MANHOLE® E5.00 N ALT R.REPAIR OR ABANDON HOU5E HWV.OR ST.WIDENING Z SE ER UI POSAL STEM 53.00 STATE ENCROACHMENT PERMIT NO. 'INDUSTRIAL . WASTE APPROVAL OWNERS PERMIT s -el,_nn_ CONNECTION CHARGE FEE CHARGES AUTHORIZATIONI TOTAL FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTI pW EL IN TO THE PUBLIC SEWER. APPROVALSDATE INSPECTOR'S SIGNATURE SIGNED THIS AV OF _ OWNER OR / NEW HOUSE SEWER OWNERSAGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) HEREBYTH LEDGE THAT HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THHAIAT THE ABOVE IS CORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING PLUMBING AND SEWERS, CESSPOOL ElDRYW ELL C:11 HEgEBY CERTIF HAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR,SEWER OR LICENSED AS RE RE BY LOS 4NGLE5 COUNTY N° STATE OF SEWAGE°15P05pL SYSTEM CALIFORNIA OR HAT I M THE LEGAL NER OF, q p INTEND TO DISCONNECT PLUG AND RESIDE IN. T ABOVE DESCRIBED R I NTIA P PEATY. ABANDON HOUSE SEWER SIGNATURE '1, FILL SEPTIC TANKS ❑ OF PERMIT E. PITISI ❑ CESSPOOLS ❑ VALIDATIONO ROBERT WOOD cK. M.O. cpsH SUPERVISING MECHANICAL ENGINEER jL100304� ADR 611D 25.00"