HomeMy Public PortalAbout9642 BROADWAY_Sewer__ =°;E-6311.°° APPLICATION FOR PERMITS-6
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGGE DISPOSAL
Depoxtmeat of County Engineer
County of LOB Angeles BUILDING r/G3b
JOHN A. LAMBI£, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT or BUILDING LOCALITY
EA
NREST
FOR APPLICANT TO FILL IN CROSS ST.
edM ^
LEGA L
DESCRIPTION LOT NO. OWNER
BLOCK TRACT ' I MAIL p
_ pp L/ V.[y,<p L,(,e,t,s(� ADDRESSNO
O'fXys'P/rL NOWOON LOTS
SIZE OF LOT CITY TEL. NO.
USE OF
BUILDINGS - OISTRI T N0. GROUP MAP
CONTRACTOR
/
7 BK
IS
5
CONNECTION DATA
ADDRESS ✓L A. j
\
STATION DEPTH
(O
CITY de TEL. NO. yo MANHOLE REFERENCE UPPER I
♦}^TATE N BR`
REGISTRATION NO. /J L�• / ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CO ECTION LENGTH F OM
PUBLIC SEWER @ $3.50 Y, CUR P.L. M.L. TO .L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELDrni $3.00 +f ,y p
OVERFLOW SEEPAGE PI ELL,AIN HOLD CO. IMP. NO.—I •/ POB (0.
OVERFLOW
OW CESSPOOL,DR YWEL ELL,MAN ISLE @ $2.00 —r-a
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM C $1.00 TRUNK PERMIT NO. PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 O O PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 DO
AUTHORIZATION TOTAL FEE 0 a REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DAT INSPE TOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NII t^
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR �* BUILDING OR WORK
OWNERS AGENT cc SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACI dOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYW ELL❑
AND STATE THAT 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 ANO
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 A THE LEGAL OW R OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTE
JOHN A. LAMBIE. CO Y ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PLBG. INSPECTOR
CASH
��(�5 9 1 4 MAR 1 l 4 2.00
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUnMING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENDINCER I AB,00flES8
FOR APPLICANT TO FILL IN LOCALITY C-
ADORESDING �- b-L1-'- e. ...ST. TSN! P /
LOCALITY DISTRICT NO. Ready for Ineoec0on PERMIT NO.
NEAREST l✓ 3 G 38`3 5
CROSS ST.4 ��
- RECEIVED BY ' DATE — ISSUED BY DATE
OWNERMAIL
ADORES ,� L ,_,fyT U/SEZONE OCCUUPANICCY, BK MAP FG Y
CITY TELAO. i Obi L/ ,0 yd��L L ,c
CONTRACTOR �,GL' y�If �
q ��� ( -��y CO.IMP.N0,
ADDRESS ;f/— 60 �� sQA�
1 s n )OB N0.
CITU �UI�� •���• TEL.NO. !a
�, _?,P' TRUNK PERMIT NO
REGISTRATION NO. ��,��l.3'C'- �� 879�A —
WTE`Y•
ROAD PERMIT NO. � D
�7
DE8CR/PTION LOT NO. a Y�f' } O STATE ENCROACHMENT
PERMIT NO.
BLOCK TRAGT �,�t �. ��� INDUSTRIAL 1
WASTE APPROVAL -
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER $ 3.50 RECEIPT NO. TE IBY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 67D
— ALTER OR REPAIR EXISTING NO. I DATE BY SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/DR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS ANO/OR GRAINFIELD 2.00 STATION �'if"x�j DEPTH
CESSPOOL—DRYWELL o
SPECIAL CONDITIONS ONLY 2.00 �(;t / C O JH ANF) , eCF'RE ..
�B §B
O CTSYPE OF CCO B N E•,T�I Q�(D PE LENGTH FROM q /
OWNERS PERMIT = Y. CURB P.L. M.L.TO P.L. I y
AUTHORIZATION TOTAL FEE O
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER�y
SIGNED THIS_�'1.=--DAY OF_rarcc m 19.x. NEW HOUSE SEWER
OWNER OR // ��/1 CONNECT ADDITIONAL
OWNERS AGENT);/,C..Sr.:.-_ BUILDING ORWORK
yy / SEPTIC TANK,SEEP.PITS)
ADDRESS..�.L_.>3..t'.._L...v_. I1.Z!-Y�'�'-4t^R .^ .- .__.. AND/OR DRAINFIELO
I HEREBY ACKNOWLEDGE THAT I HAVE READ T IS APPLI- CESSPOOL Q DRYWELL
CATION AND STATE THAT THE ABOVE IS CORREC ND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/Oil LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEW ER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE any -/[ ,p� SEEP.PIT(S)Q CESSPOOLS
OF PERMI TTEE_jZ...- .!%Z
76A642D S&E 663 4/54