The URL can be used to link to this page

Home My Public Portal About9661 BROADWAY_Sewer__ J ' _ _4 J CEBOB3 78A8920D62 APPLICATION FOR PERMIT I.I COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. County Engineer ADDRESS WILLIAM A. JENSEN. SuP•t o1 Building LocAUTv NEAREST FOR APPLICANT TO FILL IN ROSS ST, LEGAL DESCRIPTION LOT NOht 1-0 � SSS C�� 7� OWNER �.�� /JD�`�/��j ��/ MAIL /�/ VJ / BLOCK TR A<T _v /I ,� '� r/G/�/. AOC RES. NO. OF SLOGSGS. J 512E OF LOT NOW ON LOT CITY C-j EL. NO. USE OF DISTRICT N GROUP MAP PROCESSED BY BUILDINGS ��J��LG_4J BK PG CONTRACTOR ///�,'�yy�,'v/��!•py%� E / 3 ADDRESS CONNECTION DATA CITY _/11ON .EPTH TATE MANHOLE REFERENCE REGISTRATION NO. ISO �TFL'CT" COUNTY LOWER NO. DESCRIPTION OF WORK FEE T EOFC N LENGTH .ROM �� Y HOUSE SEWER CONNECTING TO - Y. C M.L.TO L. O PU BLIC SEWER ® SS.00 SEPTIC TANK.SEEPAGE PIT OR �� rJ P.C.NO. u PITS AND/OR DRAINFIELD SI0.00 CO.IMP. NO. 1/ JOB NO. �] ( HOUSE SEWERCONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO,T PRIVATE DISPOSAL SYS TEM @ s,, O I p7 0 CONNECT ADDITIONAL BLDG.OR AFFIDAVITw Alv[A 10k5tx14T 1[5[x1RECORD.INSTR,NO. DATE .WORK TO HOUEESEWER f3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL.MANHOLE® SS.00 ' ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING L SEWER OR DISPOSAL SYSTEM ® 53.00 STgTE ENCROACHMENT PERMIT NO. 1 INDUSTRIAL WA E APP OV GES OWNERS PERMIT s z o0 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST IND DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS 'DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.BEEP,PITIs) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT,THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY' THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT A _THE LEGA OF. AHO INTEND TO RESIDE IN, THE ABOE D SCRIBED OENTI PROPERTY. DISCONNECT PLUG AND ABANDON HOUSE SEWER SIGNATURE - OF PERMITTEI / BACKFILL S EPTIC TANKS ❑ E �j ❑ BEEP,PIT(S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD cK. M.0. CASH SUPERVISING MECHANICAL ENGINEER u,Uo2 3 7 7G tsfle22 1 0 D 17,0.0- Q a, \Tr1'l/ CEA8B = Bae To213 APPLICATION FOR PERMI zD COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION FSE.T Lo1NG JOHN A. LAMBIE, County Engineer RESS _ / _ WILLIAM A. JENSEN, Supt of Building r1 FLITY R FOR APPLICANT TO FILL IN S ST. - DESCRIPTION LOT NO o J J_ OW LRBLOCK TRACT ' / RESS SI2E OF LOT NOW ON LOT I CITY ' TEL. NO. UBE OF - ^,.��/�� OIS'RI�N GR� MAP PROCESS,FD BY BUILDINGS G2� LP. ^ CONTRACTO�� r�¢/� • ! � / � L j f ✓ /// JJJ ADDRESSL�Q OI�/j�({ / CONNECTION DATA CITV� L�/ E"L. NO. / 0 BON DEPTH Q/` COUNTY MANHOLE REFERENCE REGISTRATION NO, tiJ [ LOWER NO. DESCRIPTION OF WORK FEE PE OF N C O LENGTH FROI. HOUSE SEWER CONNECTING TO Y. M.L.TO P.L. PUBLIC SEWER SEPTIC TANK.SEEPAGE PIT ORNO. V PITS AND/OR DR INFIELD SIO.00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TOTRUNK PERMIT NO. ROAD PERMIT NO. CONNECTPRIVATE ADDITIONAL DITI NAL TEMBLD 53.00 CORKTONOUSC SEAL BLDG.OR AFFIDAVIT •IV SE�[Ni RECORD.INSTR.NO. DATE `1Wr/ WORK TO HOUSE SEW ER 0 93.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL.MANHOLE 0 95.00 �yy ALTER.REPAIR OR ABANDON HDUBE HWY.OR ST.WIDENING L SEWER ROIBP SA B TEM 93.00 ,...++ STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE 3PPRO VAL OWNERS PERMR $ Bn AUTHORIZATION TOTAL FEE T CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. - APPROVALS DATE INSPECTOR5 SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BU ILOI NG OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRA;N FIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY OROINANC ES AND STATE LAWS REGULATING PLUMBING AND SEWERS_ CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES'COUNTY AND STATE OF SEWAGE OISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OF. AND INTEND T RESIDE IN, THE ABO ESI."RIB D ENT PROPERTY. DISCONNECT PLUG AND Y ABANDON HOUSE SEWER SIGNATURE BACK FILL SEPTIC TA NNB ❑ OF PERMITTEE_ _ SEEP. IT I. ❑ CESSPOOLS ❑ /VALIDATION ROBERT A. WOOD (CKSUPERVISING MECHANICAL ENGINEER CK. M.0. CASH L102376G AA Pt ':211 U 25.00-