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Home My Public Portal About9535 BROADWAY_Sewer__ o a&E-669 9-39 APPLICATION FOR PERMIT B @ �6 DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer - County of Los Angeles BUILDING ADDREBUILD" S ,r L WM,J. FOX, COUNTY ENGINEER j � CASBATT D. GRIFFIN, BUP'T OF BUILDING LOCA Li T� FOR APPLICANT TO FILL IN NEAREST CROSS ST LEGAL DESCRIPTION LOT N0. OWNER ,� BLOCK TRACT MAIL p�sy ADDRESS c I�Ldp--ty —•—r //qq { ry /Y NO. OF BLDGS. SIZE OF LOT �l/}. vL�' NOW ON 60T CITY TEL. NO. USE OF BUILDINGS FN K,� ,,/ DISTRICT NO. GROUP 1 CONTRACTOR �AyL / L.Gti.t�li Y YC�PG s II� A ADORES S CONNECTION DATA CITY TEL. N0. ., 7 L STATION DEPTH / -STATE MANHOLE REFERENCE UPPER REGISTRATION NO. (/V b Ll COUNTY LOWER -NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO PUBLIC SEW ER g 3.50 Y. CURB P.I. M.L. TO P.L. @ HOUSE SEWER CONNECTING TO S L PRIVATE DISPOSAL SYSTEM 1-00 __ CONNECT ADDITIONAL BLDG. OR P. L. NO, WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOB N0. ALTER OR REPAIR EXISTING ' SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE I AND/OR DISPOSAL SYSTEM 1.00 PER NO. 5 L-A_ d� Tp.pq p \^ SEPTIC TANK. SEEPAGE PIT OR - PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL- DRYW ELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES PERA2P1' CONNECTION CHARGE FEE FL� Q vOWNER'S s I DD AUTHORIZATION TOTAL FEE /�L REIMBURSEMENT FEE v`z7 @C?7 QT` I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DES BED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THEPUBLICS viR ��""(I NEW HOUSE SEWER SIGNED THI —DAY OF 1a.�1 _ 'Z��55 1,....• ---- OWNER Oft CONNECT ADDITIONAL OWNERS AGE1 BUILDING OR WORK SEPTIC TANK,SEEP, PIT(S) ADDRESS _ AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR,SEWER OR PLUMBING AIJD SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY T, I AM PROPERLY REGISTERED AND/OR LICENSED AS REQ' I Ru 8 LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEVIER DESCRIBED RESIDENTIA PROPERTY. BACKFILL SEPTIC TANKS � �• r ® SEEP. PIT(g) CESSPO OLE ❑ SIGNATURE OF PERMITTEE WILLIAM J. FOX, COUNTY ENGINEER VALIDATION R. A. WOOD, CHIEF PLOG. INSPECTOR _.AC07 3 2 9' AUG 31 4 4.5 0 X07'3 3 0 12 AUG 31 9 5 1 0.0 0 Ala 96.6420 7 6aE-66312-54 APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL , Depoatmenl of County Engineer County of Los Angeles BdILDING m4=- BUILDINGS - ADDRESSQ�•LC/-C..•WM. J. FOX. COUNTY ENGINEER CASSATT D. GRIFFIN. 6uPT'oF ButLDw6 LOCALITYFOR APPLICANT TO FILL IN NEAREST.CROSS ST.LEGAL DESCRIPTION LOT NO. jOWNERBLOCK TRACT YJL •`I / / Jj�if MAILADDRESSN0. OF BLDGS.SIZE OF LOT JF) y/f�. j7NOW ON LOT CITY I'�3 USE OF \ I BUILDINGS f�/LF /JIJ i///i DISTRHOf NO. GROUP MAP _ BK -_PGr CONTRACTOR [ / ADDRESS _ CONNECTION DATA CITY. TEL. NO. STATION DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO. ❑ COUNTY UPPER /LOWER TYPE OF CONNECTION LENGTH FROM / NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L. HOUSE SEWER CONNECTING TO / •PUBLIC SEWER ' Q $ 3.50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM I.00 CONNECT ADDITIONAL BLDG.OR CO. IMP. NO. - JOB. NO. WORK TO HOUSE SEWER 1.00 _ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO, DISCONNECT AND ABANDON SEWER STATEENCROACHMENT .AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK,SEEPAGE PIT OR / _ SPITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL- DRYWELL -- WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 __ / CHARGES ` - -- «CONNECTION CH9AGE FEE PERMIT OWNER'S $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELL114 APPROVALS DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY.OF - 19 NEW HOUSE SEWER OWNER OR - " " - CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK, SEEP, PIT(S) ..•+ ADDRESS AND/OR-DRAINFIELD I. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS 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 AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY'AND STATE OF ,ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWR R OF THE ABOVE DESCRIBED RESIDENTIAL R ERTY BACKFILL SEPTIC TANKS ElSEEP. PIT(S) ❑ CESSPOOLS❑ SIGNATURE OF PERMITTEV ��• _ _ _ - WILLIAM J. FOX, COUNTY ENGINEER — VALIDATION -ACo? 2 9 5-;'-AUG 30 3 9.- 7.5.0 O A 10 :.-, .;BY _ BY DEPUTY DEPUTY BY BY ® DEPUTY DEPUTY