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Home My Public Portal About9334 BROADWAY_Sewer__ CE808 0 10-63 6A64 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BOILDING JOHN A. LAMBIE. County Engineer ADDHEss ✓__) / WILLIAM A. JENSEN. Sup't of Building LOCALITY NEp REST FOR APPLICANT TO FILL IN `ROSS ST. LEGAL ` I O OWNER yv /v •J I I DESCRIPTION LOT NO. MAIL BLOCK TRACT wA G ADDRESS NO. OF BLOOD. SIZE OF LOT NOW ON LOT I CITY TEL. NO. USE OF BV ILOINGS /� DISTRICT NO. G,R�/O/U��P MAP PROC 6ED BY PG CONTRACTOR YJ�/1 / �/� - T/� .A/� yl '� 0 v BK 111---r> - /33 ADDRESS / l- m A tjY - G / CONNECTION DATA �/ CITY TEL. NS ljf TION � 5TATE MANHOLE REFERENCE-_ '� U REGISTRATION ND. lt' COUNTY44 NO. DESCRIPTION OF WORK FEE TYPE C N��jj E��CTION LENG 1 FROMq HOUSE SEWER CONNECTING TO 'axx �C,IlfjN,J P.L. M.L. OP.1 _/ A RU BLIC SEWER @ $5.00 CG NO. SEPTIC TAK,SEEPAGE PIT OR JOB O ITS ANG/OR GRAINFIELD @ $IO.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMITy PRIVATE DISPOSAL SYSTEM C $3.00 -5�9/ O CONNECT PDDII ONAL BL06.OR AFFIDAVIT Ery SSMExt RECORD, INSTR.NO. DA E WORK TO HO USE SEW" @ E3.00tj OVERFLOW SEEPAGE P.T.DRA I N FI ELDI W E%TN..CES SPOO L,DRYWELLMANHOLE® $5.00 / E n ALTER,REPAIR OR ABANDON HOUSE HWYD T,.� WI N f ' SEWER OR DISPOSAL SYSTEM E3.00 STATE ENCROACHMENT z PERMIT NO. INDUS RIAL WASTE APPROVAL PPROV AL OWNERS PERMIT s 2 00 CHARGES AUTHORIZATION TOTAL FEE o , 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 DAY OF 19_ OWNER ORNEW HOUSE SEWER �� OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD 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 1 AM PROPERLY REGISTERED PND/OR ALTER.REPAIR,SEWER OR LICENSED AS REOUINE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR T AT M THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE P O ESCRIBE RESIpENTIpL pgOPERTY. ABANDON MOVSE SEWER $IGNATUflE BACKFILL SEPTIC TAN K$ ❑ OF PERMITTEE SEEP.PITIS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. ui O8 8 0 7G FES23 1 0 D 7.00- CE608 10-63 76A642D APPLICATION FOR COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION TA INc IDRN A.A. JENSE, County Engineer ESS WILLIAM A. IENSEN. S.,'1 0l Building T LITY / EST FOR APPLICANT TO FILL IN CROSS ST. LEGAL �/ rsI '�� DESCRIPTION LOT NO. OWNER BLOCK TRACT `-yl�, OF OGS. /(j'. / F{� ADDRESS N/O. OF BLOTS. SIZE OFt1 LOT NOW ON LOT r CITY TEL. NO. USE ON DISTRICT NO. GROUP] MAP ROLE ED BY BUILDING N BK ]PG T CONTRACTOR 2 SC �lF / 0NS�2 C4� l{/ ✓ /.�3 wDDREss9 / h/ y„, p Nf - CONNECTION DATA )J CITY TEL. NO. % JIT/THDNZ��2'/* DEPTH 3 p� STATE MANHOLE REFERENCE " W/ T REGISTRATION NO. '/� COUNTY OWER NO. DESCRIPTION OF WORK FEE TYPE CO N TION LEN TH FROM "OU BE SEWER CONNECTING TO Y SIJ P.L. M. TO PUBLIC SEWER ® $5.00 y P.C.NO, SEPTIC TANK,SEEPAGE PIT OR �I PITS AND/OR DRAINFIELD ® EIO.00 CO,I.P. NO. JOD NO. O V HOUSE SEWED CONNECTING TO TRUNK PERMIT NO, ROAD PERMIT N PRIVATE DISPOSAL SYSTEM 83.00 K CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAVERs[v[ RECORD.INSTR.NO. DA E O WORK TO HOUSE SEWER 33.00 V OVERFLOW SEEPAGE PIT,GRAINFIELD W EXTN..CESSPOOL.DRYWELL.MAHHOLEf3.00 a ALTER,REPAIR OR ABANDON HOUSE N SEWER OR DISPOSAL SYSTEM 53.00 TATE ENCROACHMENT Z PERMIT NO. INOU5TRIAL WASTE APPROVAL OWNERS PERMIT Sil AUTHORIZATION TOTAL FEE O CONNECTION CHARGE FEE CHARGES '1 HAVE AT THIS DATE w CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR5 SIGNATURE SIGNED THIS DAY OF 19_ OWNER ORJ� ' NEW HOUSE SEWER OW NERE AGENT A C. VV CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP.PITIS)- 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD ANO STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CEOTI FY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER I. AND INTEND TODISCONNECT PLUG AND RESIDE IN, THEABOV DE5CRIBEO E ENTIAL PROPERTY. ABANDON HOUSE SEWER $IR OF RES E BACKFILL SEPTIC TANKS ❑ OF PEMITTEE_ SEEP.FITI51 ❑ CESSPOOLS ❑ DVALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. `AGO 8 8 0 843 FEB 2 3 1 1 D 2 5 .0 0, v