HomeMy Public PortalAbout9642 1/2 BROADWAY_Sewer__ ==E<s 31,.95 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND. SAFETY SEWER-SEWAGE DISPOSAL 1
Department of County Engineer
County of Los Angeles BUILDING ,/ / A�(( /
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �Z.;,y f -'Q LL Zit rE.a/
® CASSATT D. GRIFFIN, SUPTGF-B WLOIrvG LOCALITY
FOR APPLICANT TO FILL IN taoss
LEGAL 1 AI !� P T
DESCRIPTION LOT NO. Vy/ ZFJ Qr/+ •� g OWNERMAIL
BLOCK TRACT 6� j it � AGGRESS "
�¢Cy-NOBL .CITY TEL. NO,
SIZE OF LOT L7T�( // NOWWO ON LOTT
USE OF —� -
BUILDINGS �S DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR
ADDRESS j/�i(•j' %�,�zP �� r CONNECTION DAT
CITY • '• TEL. N0. ' 7 /. I��'- TIO t{7 / DEPTH '
MANHO REF NCE UPPER
LL-STATE LOWER
_REGISTRATION NO. ✓• COUNTY
.NO. DESCRIPTION OF WORK FEE a:
HOUSE SEWER CONNECTING TO TYPE OF CONNECT LEN H FROM -
1 ;o Y. CURB J M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS ANO/OR DRAINFIELD @ S 3.00
OVERFLOW SEEPAGE PIT. GRAINFIELD 'P..C: NO.
EXTN.,CESSPOOL,DRYW ELL,MANHOLE @ S 2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @. S 1.00 TRUNK PERMIT NO. .' ROAD PERM17 NO.
CONNECT ADDITIONAL BLDG.OR -- STATE ENCROACHMENT
WORK TO HOUSE SEWER a $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
` SEWER OR DISPOSAL SYSTEM - @ 3 LOU WASTE APPROVAL
CHARGES
CONNECTION CHARGE'FEE
OWNER'S PERMIT S t 00
REIMBURSEMENT'FEE_
AUTHORIZATION 'TOTAL FEE � - _
I HAVE.AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE ,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC.SEWER. NEW HOUSE-SEWER.
SIGNED THIS DAY OF ig— CONNECT ADDITIONAL '
OWNER OR T— A_'
)' 'L BUILDING OR WORK - -
OWNERS AGENT Vim_ SEPTIC TANK,SEEP,PIT(S)
ADDRESS ANO/OR DRAINFIELD' - -
HEREBY ACKNOWLEDGE THAT 1 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.
I HEREBY. CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR AND
-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT ABANDON HO PLUG PLUGUSE D
CALIFORNIA OR THAT, 1 -AM THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS-❑
11 !\A / SEEP. PIT(S) O CESSPOOLS LJ
of
sem' F•scr-'-fTr •i(" '
OF PERMITTEE - •
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIONS ROBERT P?, WOOD.CHIEF'PLBG...INSPECTOR
01,0,6 5 FEB. .']' 4- A. 4.50 M: