HomeMy Public PortalAbout9438, 9434, 9432 BROADWAY_Sewer__ s- -'fDFFATTMENT OF COUNTY FNGLVEEn '' 1,t SEWFR=SEWAGE DISPOSAL 1
- DIVISION,OF BUILDING AND SAFETY )g,4,y PERMIT APPLICATION "
COUNTY OF LOS ANGELES
I WILLIAM J. FOX. COUNTY ENGINEER �f BUIDDLDI
� SS NG
4L e ;I ARE
FOR APPLICANT.TO FILL IN Locnury TG,
BUILDING // / ry��"j NEAREST
ADDRESS �^y �/7 �Y r�r+�'77��. /1�.eef�/.I �OWSS ST.
LOCALITY ^ /DISTRICT NO.-_ SERIAL NO. PERMIT N0:
" `/ ✓ A �6. 7�� S
NEAREST /J //
.CROSS ST. ��(YU-CTij� . v -
_ ,. R/E�CEIV �JBY''JJ '• Reedy for Inspection I• + DATE LSSU/E j1
OWNER �� !/f C / / i 1 1l• ���Z/�t�
MAIL / / � USE20NV " OCCUPANCY - BKS PG
ADDRESS `7` ^7—•(^4,/�Yl ...
CITY TELNOO. U / I L(" ��� 4 /32-
CONTRACTOR
3 Z
CONTRACTOR TwO/�f f(�+:t_i}J!''•I J Co.Imp.NO.
ADDRESS ��' �J/V%a.� 11e A- LJ� . JOB.NO.
CITY " � TELAO.�rL/f�/(f I +
7 n� + TRUNK PERMIT N0.
./.r2 ❑ STATE` 4 /72 ,7
REGISTRATION'NO. qq)!n� J"+-.+•��V:z R=CBUNTY- ROAD PERMIT NO.LEGZ �"" 7 Z '
DESCRIPTION „LOT NOCI �/y 9 STATE ENCROACHMENT
_ O. O/f.`/• /Y• _ PERMIT N0:
BLOCK TRACT `y ^ �pr ,.�j INDUSTRIAL
WASTE APPROVAL
S1ZE OF'LOT a NOW ON LOTS CHARGES
USE OF
BUILDINGS / ��_ CONNECTION CHARGE EE
�f"/
NO. DESCRIPTION OF WORK FEE"
REIMBURSEMENT FEE'
� HOUSE SEWER CONNECTING TO �
. PUBLIC SEWER @ $ 3.50 RECEIPT NO. GATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM -1.00
CONNECT ADDITIONAL.BLDG._OR E)' EPTION RE�.ORD ED _
- WORK TO HOUSE.SEWER 1.00 ��- NO
ALTER OR REPAIR EXISTING - DATE IBY -
SEWERORDISPOSALSYSTEM LOD
DISCONNECT AND ABANDON SEWER -
AND/OR DISPOSACSYSTEM LOo - ' - - CONNECTION-DATA
-. SEPTIC TANK,SEEPAGE PIT OR 474,g7
/
PIT$AND/OR DRAINFIELD 2.00 STATION T'746 7a- - DEPTH -
CESSPOOL—DRYWELL '
SPECIAL CONDITIONS ONLY 2.00
`-` 3 - MUPPER EFERENCE/�i
LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS ' PERMIT ; t-_Op �' �UR61 RLs M.L.TO-P.L. Z S
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE.CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INS P!CJTO R'St61G N+lTURE DATE -
DWELLING TO THE PUBLIC SEWER ."�y„Lc�!
NEW HOUSE SEWER -� p
SIGNED THIS---�...� -DAY 0F__�2' .____.19��
OWNER OR a /�. r - CONNECT ADDITIONAL - - - -
.Gli+• — BUILDING OR WORK
OWNERS AGENT.------�-j---_....__..._ .-------- --•----. SEPTIC TANK.SEEP.PIT(S)
ADDRESS.....".9..L/:Sy.:!�.__! d:�.*�.-.'�: _.! :: AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE-READ THIS APPLI- 'CESSPOOL;-DRYWELL O—.
CATION AND STATE THAT THE ABOVE IS CORRECT'AND.AGREE
,70 COMPLY WITH'ALL COUNTY ORDINANCES AND STATE LAWS -ALTER,'REPAI R,SEWER OR
REGULATING IPLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT .1 AM PROPERLY REGISTERED DISCONNECTPLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY -
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OFTHEABOVE DESCRIBED RESIDENTIAL PROPERTY. ,.BACKFILCsEPTic TANKS \_
SEEP PIT(S)El CESSPOOLS❑ SC_I lY t)
SIGNATURE
OF'P ERMITTEE:w'L.._..._.._"".._" .+s /•y
76A642A 663 7/53 1,r.R aa--V.07-7 •
n
24650'INSERTS.:
"°° -60 APPLICATION FOR PERMIT
Taneaxo COUNTY OF LOS ANGELES SEWER—SEWAGE, ,DISPOSAL
DEPARTMENT OF COUNTY ENGINEER '
BUILDING AND SAFETY DMSION :BuuDInG
ADDRESS
jLL A. LAMBIE, County Enginou ,
.WILLIAM A. IENSEN, SuP'1 of Building !LOCALITY
NEAREST ,
FOR APPLICANT TO FILL. IN CROSS ST. L Lb =
'LEGAL O 2 OWNER �.'. -
DESCRIPTION - LOT N0. 1 -
BLOCK TRACT MAIL
ppq ,/ q ADDRESS ,R
SIZE OF LOT,97134 ^zIG/•�9 NOW ON LOTS CITT C > TEL NO..
USE OF DISTRICT N0. GROUP I MAP ^• PROCESSED BY
BUILDINGS
�] BK 'PG
CONTRACTOR V 37 l �
ADDRESS :�, CONNECT ON DATA '"
CITY I TEL.N0. ;STATION DEPTH
TATE !MANHOLE REFERENCE UPPER
REGISTRATION NO. COUNTY ILOWER
NO. DESCRIPTMN OF WORK FEE
HOUSE SEWER CONNECTING TO W. /
PUBLIC SEWER @ $3.00 TYPE OF CONN E ION LENGTH FROM
-
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00 -
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.. CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ SLOB CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR
ORK TOHOUSE SEWER S1.00 TRUNK PERMIT N0. ROAD PERMIT N0. O
W . @ O
SEWER" HOUSE @ Et 00 ii-A "STATE ENCROACHMENT - O
V 'PERMIT NO.
INDUSTRIAL - U
WASTE APPROVAL W
CHARGES N
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 1/ C REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN-NAMED CON- _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING [ABANDON
APPROVALS DATE- INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. - - dd-
SIGNED THIS�_DAV OF I; - 19-1EL HOUSE SEWER
OWNER A NECT ADDITIONAL
OWNERS AGENT CONNECT
D WORK
ADDRESS 3 TIC TANK,SEEP.PIT($)
/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ IS-APPLICATION - - - - -AND STATE THAT THE ABOVE IS CORRECT AND A EE TO COMPLYSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS'REGULATINGER.REPAIR,SEWER OR
PLUMBING AND SEWERS. - AGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORONNECT PLUG ANDLICENSED AS REOU IRED BY LOS ANGELES COUNTY.AND STATE OFHOUSESEWERCALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEDESCRIBED RESIDENTIAL PI{OPE Y. KFILL SEPTIC TANKS I]P. PIT(S) ❑ CESSPOOLS.❑
SIGNATURE -OF PERMITTE -
Or VALIDATIOSI-1 ROBERT A. WOOD
CK. Y.0. (�CASHSUPERVISING MECHANICAL ENGINEER -
(ono 5,3 4' 4 :NOV 21 i o . _ ..3 .0 0