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Home My Public Portal About9664 BROADWAY_Sewer__ :cne<m " APPLICATION- FOR PERMIT fAEBDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of Loa Angeles BU I LI 4/ WM.J. FOX, COUNTY ENGINEER ADDRESS / f> Y/ 0 CASSATT D.GRIFFIN, SUPT of BUILDING LOCALITY / FOR APPLICANT TO FILL IN NEAREST SY J �• GTA' L r �j CROSS ST. '(/ LEGAL DESCRIPTION LOT NO. 3 T' A Z'� Q,w- /L'7 OWNER 2 �J I G�f 93f�BLOCK TRACTISSlON YMAIL AW /1� 1nEJ ADDRESS / Z / !Af NO. OF BLDGS. /�SIZE OF LOT NOW ON LOT CITY 1 TEL. NO _ 6 7`r USE OF BUILDINGS _ DI STRICT,jI�. GROUP MAP PC CONTRACTO �./1/ _ /3 ADDRESS — CONNECTION DATA CITYEL. N . T STATION D GJ DEPTH 8kaWi REGISTRATION NO. ❑ COUNTY[I STATE MANHOLE REFERENCE �9 1 LOWER No. '—DESCRIPTION OF WORR FEE 41 HOUSE SEWER.CONNECTING TO TYPE pYIIB ECTION LENGTH FROM @ S 3.50 �j .,ice CUPB �T Mi L. TOP L PUBLIC SEWER " 3 � �r HOUSE SEWER CONNECTING TO I PRIVATE DISPOSAL SYSTEM 1,00 / JOB CONNECT HOUSE OUNAL BLDG. OR P. C. N.WORK TO HOUSESE SEWER 1.00 CO. IMP NO NO ALTER OR REPAIR EXISTING •� SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. V DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK. SEEPAGE PIT OR PITS AND/OR DRAINFIELD 300 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL.CONDITIONS ONLY I 2.00 CHARGES PEH'vlFi' CONNECTION CHARGE FEE OWNER'S s 1 00 AUTHORIZATION 1 _ T0 REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INS CTOR'S SIGNATURE TO THE PUBLIC S _ER .,/(�- p�/�—� SIGNED THZr_2 D ' t9 NEW HOUSE SEWER PL LV Ate , OWNER OR CONNECT ADDITIONAL rC OWNERS AGENT BUILDING OR WORK / - SEPTIC TANK, SEEP. PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL(3DRYWELL❑ AMO STATE THAT THE ABOVE CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. I. ALTER, REPAIR.SEWER OR SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE AS VE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL P OPERTY./ / -SACK FILPIT SEEP. L.SEPTIC❑ TANKS❑ S) SIGNATURE CESSPOOLS❑ OF PERMITTEE ' WILLIAM J.FOX, COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR PF 33 U a OGT1 5 4 4 rJ Q n I- Tsgea2o CEBOB,D : APPLICATION FOR PERMIT 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. Supt o1 Building LOCALITY M L_4—til.�t NEAREST ?— FOR APPLICANT TO FILL IN CPO55 ST. 7eIb./p LL Y' EGAL c — DESCRIPTION LOTND. . /-3-T�3 '.'u OWNER S V_E! � :JJ--ii MAIL BLOCK MiS5.4_S3RASTV IQ-r� nl.rQ.S I ADDRESS .ACY[P SIZE OF LOT /�� (ra NOW ON LOTS / CITY TEL. NO.AI Y J USE OF r� •`k� pI.TRICT NO. GROUP MAP PROCESSED BY BUILDINGS ♦/ /`/ BK PG CONTRACTOR' A-� r • -at, I�,L` 1 - e „S0 ( \ L ADDRESS ( y-_l`_V P .--Jll/CONNECTION DATA CITY Qr EL. NO. { .�� STATION /y '�,/��,]]] DEPTH STATE REGISTRATION NO. COUNTY MANHOLE REFERENCE J/ ^ LOWER NO. DESCRIPTION OF WORK FEE TYP OF CONNECTION LENGTH FROM Y HOUSE SEWER CONNECTING TO Y: CURB P.L. M.L.TO P.L. d PUBLIC SEWER ® ".Do O P.C.NO. SEPTIC TANK,SEEPAGE PIT OR PITS ANO/OR DRAINFIELD 40 $10.00 CO:IMP. NO. HOU SE SEWER CONNECTING TO I Tq TM_T / ROAD PERMIT NO. /\ PRIVATE DISPOSAL SYSTEM 0 53.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT EE AIY cA SEgr RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER ® $3.00 .' OVERFLOW SEEPAGE PIT.DRAINFIE LO EXTN..CESBPOOL,DRYWELL,MANHOLES $5.00 d ALTER.vF✓aTCRfrO?MBCN HOUSE HWY,OR By.WIDENING P SEWER If S3.00 STATEENCROACHMENT PERMI INDUSTRIAL WASTE APPROVAL OWNEWS PERMIT $ z oo C AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGNATURE SIGNED THIS DAY OF 19_ - OWNEROR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION TIS) qND/Op DRpINIIEL.F1ELp AND STATE THAT THE ABOVE IS CORRECT AGREE COMPLY WITALL COUNTY ORDINANCES AND STATETE LAWS REGULATING PLUMBING BING ANO SEWERS. CESSPOOL ❑ DRYW ELL ❑ A _ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER. REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF -SEWAGE:PISP,OSAG"SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL ER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABOVIE 9.01RUED-.flE AL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS El PERMITTEE ❑ BEEP.PIT(S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER 4ft�, 1-s a s ::r:R g o u 5.0 0- " � 7 �` lri_i