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Home My Public Portal About9318 BROADWAY_Sewer__ 8A64I°'B2 7 D APPLICATION FOR PERMIT CEaOS COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BD aoINc A �� JOHN A, LAMBIE, County Engineer ADDREss !-- �Q WILLIAM A. JENSEN, Supt of Building LOCALITY T `"°ss FOR APPLICANT TO FII.L IN BST. r LEGAL , DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT Q ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL NO. USE OF DISTRICT NO. GflOUP MAP ESBED BY BUILDING$ OBK PG CONTRACTOR \�Vf� �!L' ADDRE,I {J �/A._/ ' CONNECTION DATA J CITY / /� ST/TION. C1F/" DEPTH ' REGISTRATION NO. �[ i COUNTY STATE MANHOLE REFERENCE} UOPPER NO. DESCRIPTION OF WORK FEE \ TYPE OF CO NN T LENGTH FROM `/ O HOUSE SEWER CONNECTING TO C' OV Y P.L. M:L TO P.L. PUBLIC SEWER ® $5.00 — SEPTIC TANK,SEEPAGE PIT OR P,C.NO. p, PITS AND/OR GRAINFIELD 510.00 CO.IMP' NO. .IDB NO. O' HO U SE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT y PRIVATE DISPOSAL SYSTEM 13.00 LLLLLL!!! CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIYC* S[MI RECORD,INSTR.NO. DATE a WORKTO XOUSESEWER ® $3.00 N OVERFLOW SEEPAGE PIT,GRAINFIELD Z E%TN.,CESSPOOL.DRYWELL.MAN HOLES SS.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM ® 43.00 1 STATE ENCRO CHMENT PERMIT NO. INOV ST wgsiE OWNERS PERMIT $ .1 Oo CXARGES AUTHORIZATION TOTAL FEE OU CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSf+EC R'9SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ $ OWNER OR A I �. I NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILOtNG OR WORK SEPTIC TANK.SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A V DESCRIBED E ENTIRE PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS C:1OF PERMITTEE E:1SEEP.PIT I51 (71 CESSPOOLS OVALIDATION ROBERT A. WOOD CASH M. SUPERVISING MECHANICAL ENGINEER CK. O. IN LCO 1 0 0 2 OCT 4 1 0 D 7.00- BA642 D o-B3 APPLICATION FOR PERMIT CE808 7 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BOILDING ` p JOHN A, LAMBIE, County Engineer ADDRESS 23 LF & QE U _q. WILLIAM A. JENSEN, Supt of Building LOCALITY 7g meo NEAREST FOR APPLICANT TO FII.L IN `ROBS ST. 1 LEGAL n DEECR IPTION LOT NO. fi/ OWNER I BA d MAIL BLOCK TRACT Me ADDRESS NO, OF BLDGS,SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILOINGS DISTRICT /NO]GROUP MAP P$G[EBSEO SY CONTRACTOR e � n � ^ ty/ •��l` Y BK ,P J\ Z , ADDRESSj� a 1 ,CONNECTION DATA CITY F -.410^ 7p TEL. G.al y' �IO S ST ION ' DEPTH Lv UP R ❑ MgNHOLE REFERNCE REGISTRATION NO. ❑ STATE COUNTY Ed NO. DESCRIPTION OF WORK FEE TYPE OF CON < ON ENGTH FROM O HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. U PUBLIC SEWER Q $5.00 � P.C.NO, SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO. JOB NO, O PITS AN./..GRAINFIELD @ 510.o0 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM 0 $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVII .S[4[7CORD.INSTR.NO. DATE C WORK TO HOUSE SEWER ® 33.00 OVERFLOW SEEPAGE PIT,GRAINFIELD EXTN„CESSPOOL,DRYWELL,MANHOLE 0 $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY. OR ST.WI NTNG 5EWI R OR OIS$1O AL YSTEM S3.00 STATE ENCROA HMENT A OO/1 ,J -ITN SSSLSS t� INDVSTRt L WASTE APPROVAL OWNER'S PERMIT s z 00 CHARGES AUTHORIZATION I TOTAL FEE p{Q CONNECTION CHARGE FEE 1 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'S SIGNATURE SIGNED THIS ttt DAY OF 19_ OWNER OR A/ d,�1 NEW HOUSE SEWER OWNERS AGENT Niel.)/ CONNECT ADDITIONAL AGGRESS BUILDING OR WOgK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(5) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR L ICSNEED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB DEBC ED RESIDNTIAL P PERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP.PIT(S) ❑ CESSPOOLS ❑ cK.0VALUDATION ROBERT A. WOOD M.0. CASH SUPERVISING MECHANICAL ENGINEER LA[;01 0 0 3Q OCT 4 11 D 25.00-