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HomeMy Public PortalAbout9665 BROADWAY_Sewer__ DEPARTSfENT OF-COUNTY ENGINEER SEWER-SEWAGE DISPOSAL ¶ DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION + COUNTY OF LOS ANGELES WILLIAM J. FOX. COUNTY ENGINEER I BUILDING ADDRESS FOR APPLICANT T fILL IN LOCALITYBUILDING Z NEAREST ADDRESS CROSSST._ Q%lbld n X / / Q/ '/ Itle''2I // P.S LOCALITY DISTRICT NO. - SERIAL-NO. 'PERMIT NO. NEAREST. S- ccs- A l 4738 J14 ts'3 5. R�EIVED BY Ready for Inspnntlon DATEISSUED 3 OWNER a -S, J s 6 J MAIL USEZONE OCCUPANCY MAP ADDRE BK PG CITY TEL.NO 4,225,W ' CONTRACTOR 1 2 74- ^( r CO.IMP.N0. L' ADDRESS JOB.N0. CITY TEL.NO _ TRUNK PERMIT NO. ITATE REGISTHATID N0. COUNTY2- /1. 'lV/r� 9 �J ROAD PERMIT N0. T a7 LEGAL DESCRIPTION LOT N0. PERMIT NO. „j-T4,3 ��Ga 3yf STATE ENCROACHMENT �p BLOCK TRACT / � CD" / INDUSTRIAL WASTE APPROVAL SIZE OF LOT 52, ,3 9 NO.OF BLDGS. NOW ON LOT CHARGES USEOF BUILDINGS CONNECTION CHARGE FEE -3 NO. DESCFRiPTION OF.WORK FEE REIMBURSEMENT FEE �7 H OUSE SEWER CONNECTING TO I PUBLICSEWER 6$ $ 3.50 �© RECEIPT NO. GATE . BY HOUSE SEWER CONNECTING TO f PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION.RECORDED I WORK TO HOUSE SEWER - 4.00 - ALTER OR REPAIR EXISTING DAZE By SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA 4 ` - SEPTICTANK.SEEPAGE PITON _ PITS AND/OR GRAINFIELD 2.00 STATIONSSP yC '�' /� DEPTH �y SPECIIAL COTNDIT ONSLONLV 2.00 /.1�. MANHOLEERREFERENCE , � IEOLOWER �TVPF ONN ECTION LENGTH FROM -f— CURB - ­P.t. M.L.TO P.L. 'OWNERS I "PERMIT $ � I 00 AUTHORIZATION TOTAL FEE .1 s 5'D - I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOV DES HIDED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THI$....� __ NEW HOUSE SEWER ) -` 3 .. -DAY OF -- --------------_-I i3 e! 7-0- N -0-S OWNER Oft .CONNECT ADDITIONAL, OWNERS AG NT .. -"_"_ .-__"_.,. - BUILDING OR WORK !�T r( r,/y 74- - - e SEPTIC TANK,SEEP.PIT(S) _ ADDRESS ._._SL..S..._ .. - AND/OR GRAINFIELD ' - 1 HEREBY ACKNOWLEDGE HAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL E] - - CA HON AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITHALL COUNTY ORDINANCES AND STATE LAWS _ ALTER,REPAIR.SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER ANO STATE OF CALIFORNIA OR-THAT I AM THE LEGAL OWN- ER OF THE ABOVE DWCIUBEPlyRESID TIALP OPERTY. BACKFILLSEPTICTANKS E SIGNATURE SEEP.PIT(S) ] CESSPOOLS ( 7-26�s3 DF PERMITTEE. .. _.�. _ __. ......... - i 6A642D 663 1/53