HomeMy Public PortalAbout9468, 9458 BROADWAY_Sewer__ 70*0420 `APPLICATION FOR PERMIT 11
bBE-6B_DIViSION OF BUILDING AND SAFETY, SEWER—SEWAGE DISPOSAL +r
Deportment of County Engineer
County of Loa Angeles, BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS— _ - -
® CASSATT D. GRIFFIN, SUPT OF BUILDING 'LOCALITY
FOR APPLICANT TO FILL IN CROSS ST. - p
LEGAL '22 , T •1 S Y OWNER
DESCRI TION LOT NO ✓
�� A MAIL' _
s LOCA `ACT �. AODq ESS
NO
SIZE OF LOT���'JA �S� NOWOON LOT$ / CITY TEL- NO.
USE OF DISTRICT NO. GROUP MAP
BUILDINGS BK PG
CONTRACTOR
ADpaess „1�� CONNECTION DATX/
CITY ./K �p TEL. NO. �� 3 L�� STATION DEPTH
MANHOLE REFERENCE _ UPPER
LOWER
REGISTRATION NO.. Z3 v Q TY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. z M.L.TO L.
PUBLIC SEWER @ S 3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD
@ $ 3.00
OVERFLOW SEEPAGE PIT..DRAINFIELD P. C.NO. .
EXTN.,CESSPOOL.DRYWELL.MAN HOLE CST S 2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
1 CONNECT ADDITIONAL BLDG. OR - STATE ENCROACHMENT
WORK TO HOUSE.SEWER @ $1.00 6 0 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE .INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (4 $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE '
OWNER'S PERMIT $ 1 OO
AUTHORIZATION TOTAL FEE Q O REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF F 19 CONNECT ADDITIONAL
OWNER OR - - BUILDING OR WORK
OWNERS AGENT SEPTICTANK,SEEP, PITIS)
ADDRESS - AND/OR GRAINFIELD
I HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[] DRYWELLE).
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR .
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM '
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY. LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER THE ABO E
DE5CRISED RESIDENTIA PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE SEEP. PIT(S{ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER_ VALIDATION - ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
- CK. tl.0. CASH
Li{ x 44 9 JAN-24 4. 2.0 0