HomeMy Public PortalAbout9527 BROADWAY_Sewer__ 76A6AZD APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING G ��� r1
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS //'' L W//
® CASSATT D. GRIFFIN.
SUP OF EIUILDON.�T LOCALITY �(„�Y
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FOR APPLIC T T CA"t ,/fp
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DESCRIPTION s�. / OWNER C4',/?,MAIL
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i, BLOCK TRACT �SS�U ✓I1= t.V �.Z A,f?I AO KESS 1537
Q �O/77 Q (/1/jI-
N0. OF SLOGS, f
SIZE OF LOT NOW ON LOT / CITY TEL. N0.
USE OF
BUILDINGS DIST�O; GROUP MAP
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ADDRESSCONNECTION DATA
CITY�� f�9�rl�.t EL. NO.G/ y- o� STATION DEPTH
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8 ,,,-STATE IL LOWER
REGISTRATION NO. y 1 ❑ COUNTY / 7 O I
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
N0. JOB NO.EXTN.,CESSPOOL,DRYW ELL,MAN HO LE @ $2.00 CO. IMP.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 / Gr ✓ PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $ I.00 - WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s 1 00
AUTHORIZATION TOTAL FEE J ) REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. I APPROVALS DATE INSP5CTO$' ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
^ TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS QA Y OF 19 CONNECT ADDITIONAL V
OWNER ORBUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP CATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE T 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 AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY OS ANGE S COUNTY AND STATE OF DISCABANONNECT
HO PLUGAUSE D
CALIFORNIA OR THAT I THE L WNER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LIEMWE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
C A1. 0. CASH
4 7 0 7 DEC 2 4 2.0 O m
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