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Home My Public Portal About9432 - 9434 BROADWAY_Sewer__ 9'7.3V FT. of N x-67.19 o-F 1-oT 'f3 E-6D S& APPLICATION FOR PERMIT 8DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Depamtment of County Engineer - UIL County of Los ® JOHN SSATT DAGRIBFFEINCSUAPn'goP Bu Lo rvcR -. NEAR FOR APPLICANT TO FILL IN CROSS ST. LEGAL L/ 7 OWNER Q/p C QN DESCRIPTION LOT NO. _!J - MAI BLOCK TRACT &q., //Y &� ADORE$$ �] N0. OF BLOGS. SIZE OF LOT ,S 'C(P NOW ON LOT CITY TEL. N0. USE OF BUILDINGS M DISTRICT NO. GROUP AP G CONTRACTOR ��©. Da Soy _T � 3GZ ADDRESS I.ZBz ^ �DaTti CONNECTION DATA CIT ' r�/GEL. N0. STATION DEPTH Q WIC 'lMANHOLE REFERENCE UPPER TE REGISTRATION NO. /1/Q O #I5 (2-74;'-E COUNTY ' LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM Y. CURB _ P.L. M L:TO P.L. PUBLIC SEWER @ $3.50 SEPTIC TANK.SEEPAGE PIT OR L q� T 67 / �7 PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO. EXTN..CESSPOOL.DRYWELL,MAN HOLE (@ $2.00 CO. IMP. NO. JOB N0. HOUSE SEWER CONNECTING TO I - - PRIVATE DISPOSAL SYSTEM @ $ 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR �/ {-� STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 +t �V PERMIT NO. ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $ 1.00 ( WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT S J oo Ob REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE V I HAVE AT THIS DATE'A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS 4DATEINSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWERSIGNED THIS Brgy J9CONNECT ADDITIONAL OWNER OR' J BUILDING OR WORK _ OWNERS AGENT_ •r SEPTIC TANK,SEEP,PIT($) ADDRESS / AND/OR DRAINFIELD I HEREBY ACKN014�L GE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ,COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW ER CALIFORNIA OR THAT 1 AM THE LEGAL O' NER OF THE ABOVE DESCRIBED RESIDENTIA PROPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE (//n SEEP. PIT(5)❑ CESSPOOLS❑ OF PERMITTEE .JOHN A. LAMBIE. COUNTY ENG EER / VALIDATI OBERT A. WOOD. CHIEF PLBG. INSPECTOR CF. .9. 0. CASH ' MO 16 7 APR 23 4 A ._ 3.0:0 :R