HomeMy Public PortalAbout9411 - 9415 BROADWAY_Sewer__ ' rI)EPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SUP'T MF BUILDIRc ADDRESB
FOR APPLICANT TO FILL IN LOCALITY E/Y7PLE C/TY
BUILDING //_ n�J/� l n�o A���� NEAREST
ADDRESS 7 / _ /l CROSS ST.
LOCALITY ( ` ��— DISTRICT NO. [SERIAL NO. PERMIT NO. C
NEAREST A CT 7� ���� `Z
CROSS ST. �{ '`/ / RECEIVED BY RsadY for Iaspxl1'. DATE/ISSSSUUEDD
OWNER ��,••�J,MAIL
- ���O�.J
ADDRESS � O y 7 , Ro's'rMkRpt7 USE ZONE I OCCUPANCY BI MAP PG
CITY7_e e TEL.NO.jq� 7
CONTRACT0 ZJ�'✓J��" .CHARGES r REIMBURSEMENT FEE
ADDRESSS/j, ' J�/�-/'� ` /j� )? REQUIRE—D
CITY l+ (�"`�/ ( TEL.NO. / 7� NOT REQUIREO'.r
REGISTRATION NO. //C T y CO.IMP. NO. CONNECTION CHARGE FEE
STA E
LEGAL 51 1: ff 0150 O 3 11//fr RECEIPT NO. I DATE I BY
DESCRIPTION LOT N0. ( p1
BLOCK TRACT /SS�O / k//jCI�?,r WAIVER FOR RECORDING
SIZE OF LOT�/ �j �NO OF BLDGS. n
1 D �_47 $ NOW ON LOT I1 RECEIPT NO. I DATE I BY
USE OF -�
BUILDINGS
NO. DESCRIPTION efF WORK FEE TB NK PERMIT NO.HOUSE
.-
PUBLIC SEWER�NNECTING TO S 3.30 ROAB PERMIT N0.
HOUSE SEWER CONNECTING TO ,STATE'ENCROACHINEAFF�
PRIVATE DISPOSAL SYSTEM IAO PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL -
WORKTOHOUSESEWER 1-00 WASTE APPROVAL
ALTER ORREPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
.�' AND/OR ANN,DISPOSALEEPAGE PI 1.00 STATION �f y,�; , DEPTH
SEPTIC TANK, RAINFIEPIT OR
PITS AND/OR
RYWEL GRAINFIELD 4.00 MANHOLE REFERENCE
CESSPOOL—DRYW ELL yBPEO �y.sE OF . LOWER
SPECIAL CONDITIONS ONLY 2.00 TYPE OF CONNECTIiON LENGTH FROM
V. ['CURB A P.L. M.L.TO P.L.
OWNERS _PERMIT = I 1 I 00
AUTHORIZATION I TOTAL FEE xy
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER a I SIGNED THIS _'.. . ..... _........... ........ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AG IT.-•.. _. .............. .......__ / ._. BUILDING OR WORK -'
ADDRESS. . .. . .. .Cry.C: .._ .-/yam+(;��- - SEPTIC TANK.SEEP.PIT(S)
/------��-- ------ ANO/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL[:] DRYWELL E
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSALTER,REPAIR SEWER -
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTI V THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR By C' S REQUIRED BY LOS ANGELES COUNTY
AND STATE OF/CALjVFORNIA OR THAT I AM THE LEGAL OWN-
ABANDON HOUSE SEWER
ER OF THE ABO; RESIDE AL PROPERTY. BACKFILL
TANKS CESSPOOLS
SIGNATURE -. DESCRIBE
OF PERMITTE _._._..._.._.._.-....-_
76A6421) 663 12/52
_ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
.,� COUNTY OF LOS ANGELES
ILD N
WILLIAM' J. FOX, COUNTY ENGINEER gDDREs59y//-/.
F R APPLICA T(Q.5 N LOCALITY y11e .
BUILDING ' Ji-� N /`y
EAREST /J
ADDRESS ` / CFIOSSST. �&S/JNJ//LO
LOCALITY 4 C,� A DISTRICT N0. SERIAL N0. PERMIT N0, c
NEAREST kj 8Z33 6ODL�/J� J
CROSS ST. 1•
� RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ' ,r5� �t/. /5• y ze/
MAIL
ADDRESS &0 'i and �_ USEZONE OCCUPANCY BK MAP PG
CITY �� �, TEL.NO.t4 3� ' E5
CONTRACTOfl _ C_(..._f_
G0.IMP.N0. _ e�`J _` R,4
ADDRESS
2 ) JO
CITY / TIELL..N 73/ :SJ-TE TRUMK F r r un
REGISTRATION NO. �/ �'Y �� NTY' y
ROAD PERMIT N0. 'z 7 7 Z 9
LEGAL
DESCRIPTION LOT NO. STALE.F,tICROACHMENT
PERMIT
BLOCK TRACT INDUSTRIAL
p / � WASTE•ARRROYAI
SIZE OF LOT �� I'JJ� N0.OF BLDGS., Z.�
NOW ON LOT CHARGES
USE BF
BUILDINGS CONNECTI ARGE FEE ,�•
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FE
PUBLICSEWER Q $ 3.50 RECEIPT NO. ATE' SV
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 OZJ
CONNECT ADDITIONAL SLOG.OREXCEPTION flECOfl DE0
_"OKTO HOUSESEWER 1.00 / <�
ALTER OR REPAIR EXISTING f NU. I DATE IBV `
SEWER OR DISPOSAL SYSTEM I.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR /
PITS AND/OR GRAINFIELD 2,00 STATION 77/7/ 1 DEPTH 6
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 - /r O/j:MANHOLE REFERENCE LOWER
TYPE OF�CONNECTION LENGTH FROM
OWNERS PER S 1 00 Y. <,CURB J P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE y,. O 0
1 HAVE THIS GATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE GATE
DWELLING TO THE PUBLIC SEWERf
SIGNED THIS----._✓T. ...DAY OF...(.. . . .. ..........__.. 19 NEW HOUSE SEWER _
OWNER OR CONNECT ADDITIONAL-
2
ILCL I II_ �/���/_`�
OWNERS AGENT... ....... . ...... .. ........ ........................_..._..._ BUILDING OR WORK f' I L!V
SEPTIC TANK.SEEP.PIT(S)
ADDRESS..... ...�. .. _...._ ..... .. ......_.........._... AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PLI. CESSPOOL 0 DRYWELL E
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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICEN 5 REOU IRE
BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OE'CAL PFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE (ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFI LL SEPTIC TANKS Ej
SIGNATURE \ SEEP.PIT(S)E] CESSPOOLS
OF PERMITTE . -
76A642D 663 1/53