HomeMy Public PortalAbout9626 BROADWAY_Sewer__ DFIPARTDiF,NT OF COUNTY ENGINFER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES I NG _ n
WILLIAM J. FOX, COUNTY ENGINEER AgUiLDiDDRESS(: pG 4-144,
FOR APPLICANT TO/FILL
�IIN LOCALITY (Z C I ' 1
ADDRESS ���/•�7���ZL ` , / NEAfl I E�YN A'71^P
CROSS 5T. l 1 U
LOCALITY / DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST Sr. IV, P� /y[/e / A Zti�BG`SCROS `3
RECEIVED BY Reedy for Ineneelian DATE ISSUED
OWNER rE w. �q{„�g�k.m" ,, 5 zn-y�
ADDRESS AIL 91C.1y- \ U/1�SE 20 aE 'OCCUPANCY
BK MAP PO
CITY TELNO Ll �I ^'1'• - 1 L�
CONTRACTOR a l „ � I C..' CO.IMP.NO. 12rl C.
ADDRESS . .o. JOB.NO. �1
► CITY �[���� TRUNK PERMIT NO. rt
REGISTRATION NO..
//36 j � -�_ / I_1>a STS ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK /2 TRACT �.,,� '/��� ' � WASTE APPROVAL
NO.OF
SIZE OF LOT G Q xAI'V7 NOW ON LOTS
CHARGES
USE OF
BUILDINGS 3- �•� �� CONNECTIO RGE FEE
NO. DESCRIPTION OF WORK FEE _
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
POUSE S WER (� f 3.50 ,4^ RECEIPT NO. BV
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWS R I.DO
ALTER OR REPAIR EXISTING NO' DATE 8V
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 - CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR T '
PITS AND/OR DRAINFIELD - 2.00 - - STATION Q `1 I l../ DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY . . . 2.00 _ (�r� /' MANHOLE REFERENCE LOWER
z11 TYPE�O CONNECTION LENGTH FROM
CURBS ,L^ M.L.TO P.L.
OWNERS PERMIT 00
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE,PUBLIC SEWER
�eI, IQ' NEW HOUSE SEWER
SIGNED THIS... DAY OF.__ .__._19 l-� _
LI �� CONNECT ADDITIONAL
OWNER OR y�y �7, 'BUILDING OR WORK
OWNERS AGENT—-
�4�_ SEPTIC TANK,SEEP.PITS)
ADDRESS....... ...^_ ..�.._._.._.. ._._.._... AND/OR GRAINFIELD
Z
1 HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLI- CESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM l
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER
-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[:] e
SIGNATURE �T, A/�� y� /� SEEP.PIT(S)0 CESSPOOLS pt-�
OF PEgMITTE E...'_:._f.. .n.. .�Y.iCN...:....��'. ......r.xi•YD
7EAO42A 663 7/53
76A642D APPLICATION FOR PERMIT,
1
S&E-665 155 ,
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING77777]
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESSCASSATT D. GRIFFIN, $lJP'T op BwLoirvc LOCALITYFOR APPLICANT TO FILL IN CROSS ST.
LEGAL "��y. OWNER0 loft
DESCRIPTION LOT NO. f—OT �9 �% 11--AA UI G4(l Q MAILC7 14/- laL4_ °�a--iX G.a
BLOCK TRACT �Y! jSS (GM1� ADDRESS
A 'I ♦ NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT Ino y 1,L NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS ,f
CONTRACTOR ��� c l(�1 �` � T
r / CONNECTION DATA
ADDRESS ' 7/' J�0 IO(,., /
g��� /r / STATION C_/Q..��l PTH
`�(
CITY H )41 TEL. NO. NVL MANHOLER EREN UPPER
(}STATE W
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECT�JN LENGTH FROM
HOUSE SEWER CONNECTING TO j TYPE QONNECV LENGTH
PUBLIC SEWER @ SRO-
SEPTIC TANK,SEEPAGE PIT OR J �J
PITS AND/OR DRAINFIELD @ $3.00 r
OVERFLOW SEEPAGE PIT.GRAINFIELD P. C. N j i// -7-�
EXTN..CESSPOOL,DRYWELL.MANHOLE @ 5 2.00 CO. IMP. NO. JOB N0. Z4
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 . 0 WASTE APPROVAL '
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S o0 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED con- APPROVALS DATE INS PECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 79 CONNECT ADDITIONAL
OWNER OR J_zip BUILDING OR WORK
OWNERS AGENTT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR GRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. CESSPOOL LlDRYWELL LIANO 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/ AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT ABANDON HO PLUG PLUGUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ER
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. CASH
I1[' 6029- CCT2410 A 3.07 IT