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HomeMy Public PortalAbout9628 BROADWAY_Sewer__ sa 55 APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Dep=hnent of County Engineer County of Los Angeles BUILDING �,6 2 JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS '✓ �,.i7 40.4yf. ^� ® CASSATTD. GRIFFIN, SUP'iofBUILDING LOCALITY NEAREST �M�/e JIC/ FOR APPLICANT TO FILL IN CRASS ST. // LEGAL �' �V' O F/.ZG Qf �� OWNER L �•4�IJYi:i. . L by 3h DESCRIPTION LOT N0. MAIL BLOCK TRACT �'7 /1r>;S•E�' Il�fb. L�-ft•r F ADDRESS �� 24 [7hInAD NO.OF BLDGS. CITY' TEL. N0. SIZE OF LOT NOW ON LOT SE OF B"LDINGS J i N� : �c s Q7�G� DISTRICT NO. GROUP MAP CONTRACTOR C D ti � � � L /BK P� , ADDRESS -Z CONNECTION DATA CITY L�� M TEL. N0.�T� �S 4/O STATION DEPTH -04 ,-J �� MANHOLE REFERENCE UPPER / -<2 _ [I COU E LOWER REGISTRATION RI I` ❑ COUNTY �j'/Z13 �+ No. DESCRIPTION OF WORK FEE — _ 6 J HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM PUBLIC SEWER @ $ 3.50 Y. CURB P.L. M.L.TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ S 3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD P. C. NO. FXTN..CESSPOOL.DRYWELL.MANHOLE @ $ 2.00 CO. IMP. N0. JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ S 1.00 d l: PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT S 1 00 AUTHORIZATION TOTAL FEE 2 ff REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS D Y OF '19— CONNECT ADDITIONAL OWNER OR ✓tii BUILDING OR WORK OWNERS AS SEPTIC TANK.SEEP,PIT(S) ADDRESS / AND/OR DRAINFIELD HEREBY AC 'NLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE TH(CT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY OS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIA PERTY. BACKFILL SEPT IC TANKS❑ SIGNATURE SEEP.PIT(S) [- CESSPOOLS❑ OF PERMITT JOHN A. LAMBIE, C NTY ENGINEER I�jALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR [&5 3 8 4-; FEB 20 4 2.0 0 °' a8° S&EAPPLICATION FOR PERMIT 1 8DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Depeztment of County Engineer County of Los Angeles BUILDING ADORL JOHN A. LAMBIE, COUNTY ENGINEER ES$ ® CASSATT D. GRIFFIN, SUPT of BUILOINc LOCALITY FOR APPLICANT TO FILL IN moss sT. ENO. ]LEGALOWNERDESCRIPTION LOT NO. ?9 /MAIL BLOCK TRACT e. vee.ln�A ADDRESS t&zs1_NO. OF BLDGS SSIZE OF LOT 60 ,( OW ON LOT CITY TEL. USE OF N BUILDINGS DISTRICT N0. VG O MAP DK PG CONTRACTOR � Q CONNECTION DATA ADDRE / /J ,n// STATION DEPTH CITY /ZRI eel �: L. NO.�f '7 7� Z MANHOLE REFERENCE UPPER �i �BTI(TE LOWER REGISTRATION N0. ❑ COUNTY No. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER §3.50 HOUSE SEWER CONNECTING TO Y, CURB P.L. N,L.TO P.L. @ BEP-144T*NK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $ 3.00 °Yz I CO. IMP. NO. -P. . /] EiFFN.,CESSPOOL,DRYW�_.�"^I�yE C $ 2.00 li 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 Cyt $1.00 PERMIT NO. ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM cu $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT g 1 OD AUTHORIZATION TOTAL FEE n 0 REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CDN. APPROVALS DATE INSPECTOR'S SIG NATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS 7 V I, —DAY OF 19' CONNECT ADDITIONAL OWNER OR QA BUILDING OR WORK OWNERS AGENT_ w SEPTIC TANK,SEEP, PIT(S) ADDRESS J /./� �. AND/OR DRAINFIELD L I HEREBY ACK01COWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE i0 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 AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 THE LEGA ER THE ABOVE DESCRIBED RESIDENTIAf ((09ERTY. BACKFILLSEPTIC TANKS❑ SIGNATURE / BER. PIT(S) ❑ CESSPOOLS❑ OF PERMITTEE JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR CK. N.0. CASH BACs 7 2 7� OCT 24 a 3.00 0 ,r r / 7BA642D APPLICATION FOR PERMIT 1 e&EeeDIVISION OF BUILDING AND SAFETY . SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS © CASSATT D. GRIFFIN. SUv'T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN caoss sr Xe�.: r Y /��d • DESCRIPTION LOT NO.15,60 �6r:9� OWNERMAIL Jy`y�/U P ON BLOCK TRACT ' ADDRESS //����ttff l'1)ru1 �� tom. SRE OF LOy/1LJAX 14`/95 NOWOONBLOTSCITY TEL, NO. USE OFBUILDINGS /2y DISTRICT NO. GROUP MAP RK CONTRACTOR k!A?.-,V' S-/ 4;,,1/1 —5� -1tM� G apoaess C,. ONNE�TION DATA jyJS" !jy„8-�Y.. �'�� 'rd—yi CITY ,YlK r TEL. NO. �j�!f/y /1.��• DEPTH ,., MAN LER F R E UPPER yj LY�O TATE O/ LOWER REGISTRATION6 ��(' ❑ COUNTYI 12 NO. DESCRIPTION PTION OF WORK FEE r TYPE OF CONNECTION LENGTH OM HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L. _ y�� SEPTIC TANK,SEEPAGE PIT OR PITS ANO/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. N0, r1� EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG. OR STATE ENCR C E WORK TO HOUSE SEWER @ $1.00 _PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL e SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROV L CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ ) 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNRTURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING y TO THE PUBLIC SEWER. NEW HOUSE SEWER v- SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER ORBUILDING OR WORK OWNERS AGENT `1 SEPTIC TANK, PIS) DRAIN ADDRESS AND/OR DRAINFIELD T D ' 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 OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. SEEPPBACKFILL(SEP❑CCTANKS❑LS SIGNATURE OF PERMITTEE JOHN A. LAMBIE. COUNTY ENGINEER VALIDATED ROBERT A. WOOD. CHIEF PLBG. INSPECTOR LK, Y.0. CASH Lf,02 s 5 N ,JuL 15 1 A 4-50