HomeMy Public PortalAbout9533 BROADWAY_Sewer__ J8A042D APPLICATION- FOR PERMIT
S&E.663 I-55 -
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
'Department of County Engineer _
•County.of Los Angeles B UILDf NG �]
AUDRE55 1 .3 �. L I l.+
JOHN A. LAMBIE, COUNTY ENGINEER _
® _ CASSATT D. GRIFFIN. SUPT or BwcDING,
LOCALITY
�� �r NEAREST -
'FOR APPLIC NT FI t caoss ST,
LEGAL Ir•Try. OWNER _
DESCRIPTION LOT NO. 7 1 c
RLOCK
,TRACT � /�X� ADDRESS et �J�, G� r�/jLL(4r'
NO. OF.BLDGS. /i1 'CITY TEL. N`O. S �'F
SIZE OF LOT NOW ON LOT /
USE OFi DISTRICT NO. GROUP MAP
BUILDINGS l SK PG
CONTRACTOR 1t /S
AODR'ESs Q�,r �* CONNECTION DATA -
�[— �'=t— TION C� .DEPTH /
CITY AfY!!L-� TEL. NOC 1 9���V/2.`5 MANHOLE REFERENC / UPPER
G T �„TpTE l LOWER
REGISTRATION NO. `- ❑ COUNTY
NO. DESCRIPTION OF ORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION _ .LENGTH FROM
Y. CURB P.L. M.L. TO .L.
_ PUBLIC SEWER @ $3.50
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C..NO.
EXTN_CESSPOOL,DRYWELL,M AN HOLE @ $2.00 CO. IMP. N0. 108 N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ' @ $1.00 TRUNK PERMIT NO. - ROAD PERMIT NO.
CONNECTADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL'SYSTEM @ ,$1-00 WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g
REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A,CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR;SSIGNATURE
TRACTOR TO 'CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _
TO THE:PUBLIC 5IE-W�E^R�. - ,.–.i�1 NEW HOUSE SEWER "
SIGNED THISl_DAY OF D 192 CONNECT ADDITIONAL
OWNER .OR BUILDING OR WORK
OWNERS AGENT- SEPTIC TANK,SEEP,.PIT(S)
ADDRESS -AND/OR DRAINFIELD ID
HEREBY ACKNOWLEDGE THAT i HAVE READ THIS AP CATION CESSPOOL Ll.DRYWELL❑
AN -STATE THAT THE ABOVE 15 CORRECT AND AGREE . COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR;SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY TH T I' AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED' Y LOS ANGE S COUNTY AND' STATE OF ABANDOWHOUSE SEWER
CALIFORNIA OR THAT AM THE 'L A OWNER OF THE ABOVE
DESCRIBED RESIDENT PROPERTY. BACKFILL SEPTIC TA NKS❑
SIGNATURE S EP.PIT(S) ❑ CESSPOOLS
OF PERMITTEE
JOHN AMBIE, C2 UNT ENGINEER VALIDATION ROBERT A. WOOD,CHIeF PLBG. INS EC -R
C M..0.. CASH
_.
4wo4 7 0 5DEC . 2 5 2.5 .0/0 a
°AE-65 - APPLICATION FOR PERMIT g
6 Q E.00DIVISION OF BUILDING AND SAFETY,. SEWER—SEWAGE DISPOSAL
Deportment of County Engineer �p
CountyAM of Los Angeles BUILDING �� 'Y 7 G -�9Og.Q
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS J.//JJ /C
m CASSATT O. GRIFFIN..SUPT OF BUILDING LOCALITY
FOR"APPLICANT TO FjLL IN A cnoss si. c� Go(yi�!@
LEGAL W: Vr OWNER ��..
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT ., .r, Qtircn AODR ESS
NO.OF BLDGS. 'CITY G TEL. NO.
SIZE OF LOT - NOW ON LOT
USE OF
DISTRICT y0. GROUP MAP
BUILDINGS
BK PG
CONTRACT
ADDRESS. ' S CONNEC_TIONDATA
.✓ $ ON DEPTH
CITY � �Z d Z L. NO. J
q_
P
7 PPJJ J ,., A HOLE REFERENCE UPPER
/ CT / / Ltl-COUN OWER
REGISTRATION NO. ❑ COUNTY (�
NO. DESCRIPTION OF WORK FEE TYPE OF CONNEC LENGTH FROM\
HOUSE SEWER CONNECTING TO ./ Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50 /(}
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
EXTN..CESSPOOL,DRYW ELL,MANHOLE Q $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR , STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00 PERMIT NO. -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT $ t 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE y
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR.SSWNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER /2
SIGNEDTHIS
��� YOF— A."CV 19s CONNECT ZONAL
OW NER.' OR W.OR. BUILDING OR WORK
OWNERS AGENT SEPTIC TANK.SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS (CATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE 0 COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1-HEREBY CERTIFYTHAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED A$ REQUIRED B LOS AN ES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I M THE E AL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAROPERTY RACKFILL SEPTIC TANKS(3SIGNATURE _ EP.PIT(S) CESSPOOL
SZY
OF PERMITTEE O
JOHN A. LA4BIE,COON ENGINEERVALIDA ION ROBERT A. WOOD. CHIEF PLBG. INSPEC OR
CN. Y. 0. CFSN
4 7 0 6 1- DEC " 2 4 4 .5 0