HomeMy Public PortalAbout9509 BROADWAY_Sewer__ 1 DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT ARPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
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ILDING c NEAREST
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CALITY - { r DISTRICT NO. SERIAL NO. PERMIT NO.
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RECEIVED BY Ready for Inspection DATEISSUED
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STATE
REGISTRATION NO. QL 7 9 6 C�`Y' z' ❑ COUNTY ROAD PERMIT NO.
LEGL DESCRIPTION LOT N0. F_Q7 1yy1 :T rtS- IoO( pERMET NO ENCROACHMENT _
BLOCK TRACT `� )9 INDUSTRIAL
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SIZE OF LOT ' WASTE APPROVAL
NOOWONLDTG
CHARGES
USEOF
BUILDINGS CONNECTION CHARGE-FEE
NO. DESC IPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER { 3.50 I SCJ RECEIPT NO. I /DATE \I BY
HOUSESEWER CONNECTING TO I/
♦ PRIVATE DISPOSAL SYSTEM 1.00
1 CONNECT ADDITIONAL BI DG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE BY \
SEWER OR DISPOSAL SYSTEM 1.00 /
DISCONNECT AND ABANDON SEWER
1 AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
S EPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIE LD 2-oo STATION 4()4-, '7 DEPTH
CESSPOOL—DRYWELL gg
SPECIAL CONDITIONS ONLY 2.001 ` �� M ANHQLRREFERENCE vOwFm
TYPE OF CON NECTION ` LENGTH FROM
OWNERS PERMIT $ I I 00 CCUNR) atmd7 M.L.TO P.L. 3b
AUTHORIZATION I TOTAL FEE 4 �S
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PU LIG SEWER
SIGNED THIS_L.. . ..._DAY OF.... .___ I,,(�� NEW HOUSE SEWER Sn yrt C�—
. ..._._ 's'-T
OWNER OR _ CONNECT ADDITIONAL
OWNERS AGENT....... BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS.............._111///..._........................................._......---------------... ARD/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL Ej DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS gLTER. REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THEILEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL/PROPERTY. BACKFILL SEPTICTANKS El
SIGNATURE / � SEEP.PIT(S)Q CESSPOOLS(� S c k
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OF PERMITTEE..._........................
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