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HomeMy Public PortalAbout9529 BROADWAY_Sewer__ 7GA 642D 11�99 E-6° 5& APPLICATION FOR PERMIT -g 5& DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer Zounly Of Los Angeles ADDRE SG `IVY�C JOHN A. LAMBIE, COUNTY ENGINEER /J ® CASSATT D. GRIFFIN. SUPr oP euuowc LOCALITY NEAREST J / '-� FOR A�PPL_ICANT TO FILL Iti ceoss sr. LEGAL DESCRIPTION LOT NO. �a.I Q� N,zZ7-,7!591 OWNERMAIL BLOCK TRACT�� Y -- ADDRESS L.ccs GZr1i N0. OF BLDGS. / CITY TELN0. '74-4-7f' 11 . SIZE OF LOT NOW ON LOT USE OF _ "We-.9 Ay-„ DISTRICT NO. GROUP' HK MAP' BUILDINGS V✓�/ _ PG J, CONTRAp S •'ADDRESS C CONNECTION DATA 4k7. 0 J�6a-5 I- MANHONE EFER CEI DEPTH — P CITY TEL. O. ` STATE - LOWER REGISTRATION N0. � [ICOUNTY OF NO. DESCRIPTION WORK FEE HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $3.50 Y. CU Re P.L. .L TO P.L. iV ` V SEPTIC TANK,SEEPAGE PIT OR I-, PITS AND/OR DRAINFIELD @ $3.00 _�iC�IG' OVERFLOW SEEPAGE PIT,DRAINFIELD ftp' C. O. !7 S� EXTN..CESSPOOL.DRYWELL,MANHOLE @ $2.00 CO. IMP. N0. y1OB NO. HOUSE SEWER CONNECTING TO 'T PRIVATE DISPOSAL SYSTEM @ $I.00 TRUNK PERMIT NO. ROAD PERMIT NO. LADDR�ESS9 ONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $I.00 PERMIT N0. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL '.SEWER,OR DISPOSAL SYSTEM @ $I.00 + WASTE APPROVALCHARGES CONNECTION CHARGE FEE OWNER'S PEITTHORIZATION TOTALFEEREIMBVR$EMENT FEE VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR*S SIGNATURE TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLINGHE POBLIC SEWER. NEW HOUSESEWER ED THI "� DA OF cA v 19 CONNECT ADDITIONALER OR. BUILDING OR WORK-ERS AGENTSEPTIC TANK,SEEP.PITS) ESS_G AND/OR DRAINFIELD EREBY ACKNOWLEDGE THAT I HAVE READ THIS APP ATION CESSPOOL❑ DRYWELL❑STATE THAT THE ABOVE ISCORRECT AND AGREETO OMPLY ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,. ALTER,REPAIR,SEWEROR BING AND SEWERS. SEWAGE DISPOSAL SYSTEM HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORDISCONNECT PLUG AND NSED AS REQUIRED B LOS ANIS S COUNTY AND STATE OF ABANDON HOUSE SEWER FORNIA OR THAT AM THE TEG L OWNER OF'THE ABOVE RIBED RESIDENTI PROPERBACKFILL SEPTIC TANKS❑ATURE S P. PIT(S) ❑ CESSPOOLSID PERMITTE _ 47 S JOHN A. LAMBI . COUN7Y ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLEIG. INSPECTOR AU0.43 0 4- DEC 2 4 4.50 M 9E-06 & APPLICATION FOR PERMIT aDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer - County of Los Angeles BUILDINGL •t p ]fin n ,/ JOHN A. LAMBIE. COUNTY ENGINEER .AD DRE �SO[ /� m CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY ZZ-4101 " ' C'// y/ e /1X/' FOR APPLICA_NT T ILL IN CROSS ST. C L�6 U C2�✓�/7 /7 LEGAL F / Sd 10SC/O.DESCRIPTION LOT O . q OWNER J�J- Irl MAIL BLOCK TRACT ADDRESS i NO.OF BLDGS. / CITY TEL. NO. ` o SIZE OF LOT NOW ON LOT / USE OF BUILNGS DISTRICT 0. GROUP MAP (` B/..K PG CONTRACTOR � /51 — ' CONNECTION ' ADDRESS DATA STATION- DEPTH CITY TEL. NO. MANHOLE REFERENCE UPPER ❑ STATE LOWER REGISTRION N0. ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONN TION LENGTH F M Y. CURB P.I. M.L.T L. PUBLIC SEWER @ g 3.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD © $3.00 OVERFLOW SEEPAGE PIT. DRAINFIELD c P . NO. EXTN..CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. VOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM $1.00 TRUNK PERMIT NO. RINQ PERMIT NO. CONNECT ADDITIONAL BLDG.ORSTATE ENCROACHMENT WORK TO HOUSE SEWER @ 51.00 PERMIT NO. ^� ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL _ SEWER OR DISPOSAL SYSTEM $t.00 WASTE APPROVAL' CHARGES CONNECTION CHARGE FEE OWNER'S PERMITS 1 DD �y` AUTHORIZATION TOTAL FEE REIMBURSEMENT FEES ' - / J R �Q I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATU RE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL ' OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED A.ND/OR DISCONNECT PLUG AND LICENSED AS REOUIREO BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑ OF PERMITTEE/_' JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK.• M.O. CA H 4653,:; Nov 2'] 36 3750-A 2. 7BA642U APPLICATION FOR PERMIT 68E6a3 11-55 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer - - County of Los Angeles BUILDING JOHN A. LAMBIE. COUNTY ENGINEER / ADDRESS ® CASSATT O. GRIFFIN. SUPT OF BUILDING LOCALITYNEAREST .�.<.,.....�-�% Zj[i[L FOR APPLICANT TO FILL i CROSS ST. A DESCRIPTION OTNO & I�2 ` OWNER MA [�� d BLOCK TRACT�1- ✓�`F/ " ADDIL RESS , tj 7I y� y ✓A NO. OF BLDGS. CITY YYY� TEL. NO. SIZE OF LOT NOW ON LOT USE OF DISTRICT N0. I .GROUP MAP BUILDINGS r ROU B+K' PG CONTRACTOR V /'L �� ADDRESS p ,-�� �� ��LI�N CONNECTION DATA_+ , .7r=L z /� L�r ION pEPTH CITY _ TEL. N0. fY�% (J MANHOLE REFERENCE �O + UPPE REGISTRATION NO./, COUNTY NO. DESCRIPTION OF WORK FEE , ,I-/ TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO T. CURB P.L. M.L. To P,L: PUBLIC SEWER @ $3.50 ` SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD © $3.00 OVERFLOWSEEPAGEPIT,DRAINFIELD P. C. NO. EXTN.,CESSPOOL,DRYW ELL,MAN HO LE @ $2.00 CO. IMP. NO. P JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ 5 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM (aI $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT s REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE ]EIN I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA - APPROVALS DATE INSPECTOR'SSIGNATURE HAVE TO CONNECT THE ABOVE DESCRIBED EXISTING TO THE PUBLIC SELER_ NEW HOUSE SEWER SIGNED THIS wL,DAY OF_�/T' O CONNECT ADDITIONAL ' OOWNER CIAWNERS AGENT ��IA BUILDING OR WORK SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD , I HEREBY ACKNOWLEDGE THAT I HAVE READ T APPCESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND A E TWITH ALL COUNTY ORDINANCES AND STATE LAWS REALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT AM PROPERLY REGISTERED ONNECT PLUG AND LICENSED AS REQUIRED BY OS ANG ES COUNTY .Np F - ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 THE L AL OWNER OF THE DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE SE PITS)❑ CESSPOOLS❑ OF PERMITTEE O t' JOHN A. LAMBIE, COUNT ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. IN EOT R CN. M.0. CASH h(o 4.7 0 31 DEC 2 �5 2 5.0 0