HomeMy Public PortalAbout9600 BROADWAY_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES A^
,
WILLIAM J. FOX, COUNTY ENGINEER
PI BUILDING (� rDn ',•./J
CASSATT D. GRIFFIN, SUPT OF BUILDING ADDRESS .0FOR APPLICANT T FILL IN LOCALITY e M1 ,LC L/ ,e
BUILDING NEAREST A /� ��
ADDRESS �� - 4&ES4 CROSS ST.TG � /B L/ ,)/ /1/ f!<'GO' Ph j7
LOCALITY DISTRICT NO. SER.IIA NNO: .^PERMIT NO. C
NEAREST 5 A ) (/—[/L/
CROSS ST;. 6 RECE VA B f Ready for Inspection DATE ISSUED 2
OWNER ui W ' S 2-II-,5,3
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
,1 BK PG
CITY TEL.NO. µms./
CONTRACTOR t , a _ �Qj V 'V CHAR ES REIMBURSEMENT FEE
ADDRESS D REQUIRED
CITY TEL.NO. /� 1� NOT REQUIRED
^J -'{y J JOB.NO. > CONNECTION CHARGE FEE
REGISTRATION N0. I�,J ��' C�7 i'� STOAT CD.IMP. N0. I Z/
LEGA O 3 ^ RECEIPT NO.^ I DATE BY_
DESCRIPTION LOT N . `'
BLOCK TRACT /�� /f/�,w•L(�-G4- WAIVER FOR RECORDING
SIZE OF LOT NO.OF BLDGS. RECEIPT N0._,_.�.L...--^DATE I BY
NOW ON LOT
USE OF
BUILDINGS _
I( No. DESCRIPTION OF WORK FEE TRUNK PERMIT xOr� �
.HOUSPUBLE SEWER SEWER CONNECTING TO @ $ 3.50 D ROAD PERMIT NO. Z�g
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
_- PRIVATE DISPOSAL-SYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND AGAR D
A D/OROSPOSAL SYSTEMN SEW ER 1.00
S EPTIC TANK,SEEPAGE PIT OR STATION 7 �J 5 DEPTH
PITS AND/OR GRAINFIELD 2.00 rE�y�-
SPECCESSIAL CONDITIONS ONS ONLY 2.00 TYPE OF CONNECTION r LENGTH FROM
)
CURB —PvL: M.L.
OWNERS PERMIT § 1 00
AUTHORIZATION TOTAL FEE 4 5d
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE GATE
�^
SIGNED THIS............----_DAY OF _._..___ ___)q........ NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT...._- BUILDING OR WORK
SEPTIC TANK.SEEP.
ADDRESS___.._ .. --_--_............... AND/OR GRAINFIELD IT/S)
......__------._............_...'''"_........_
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL Ej DRVWELL E
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR SEWER
REGULATING PLUMBING AND SEWERS.- SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL'OWN- ABANDON T PLUGSEWER
AND
q'
ER OF THE ABOVE DESCRIBED RESIDENTIAL �PR�O/PE�RRTY.Y.y/J BACKFILL SEPTIC TANKS
BEEP.PIT(5)
OF PERMITTEE_ �._`_ ......,.^!E � CESSPOOLS
SIGNATURE
76A6421) 663 12/:59