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Home My Public Portal About9667 BROADWAY_Sewer__ CEaoa 6-6eAPPLICATION FOR PER IT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOS L DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, County. Engineer CASSATT D. GRIFFIN, Sup I of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL q DESCRIPTION LOT NO. OWNER BLOCK TRACT <ZV MAIL ADDRESS NO.OF BLOBS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCES BY BK PG CONTRAC 0 G ADDRESS a CONNECTION DATA CI TEL N0. - O' ION T- V A 0 DEPTH / /L��j STATE MANHOLE REFERENCE PPER REGISTRATION NO. /s! U 4®C✓ COUNTY r ND. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO QO e0rOF uPPSR MN- PUBLIC SEWER @ $3.00 TYPE OF CONN TION LENGTH FROM / SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAI NFI ELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXT N..CESSPOOL. D RYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.N0. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. JOB N0. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 t TRUNK PERMIT N0. ROAD PERMIT NO. SEWERREPI DASPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERNBT S 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE ®d REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS - DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAA F19_ NEW HOUSE SEWER OWNER J9-'ly/fI {cv CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WWORKORK ADDRESS SEPTIC TANK,SEEP.PIT(S) ANO/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL EI DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. ALTER,REPAIR. SEWERDISPOSAL EM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGDISCONNECT PLUG ANO LICENSED AS REOUI RED Y LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT M T LEGAL OW OF THE ABOVE DESCRIBED RESIDENT NO TY BACKFILLSEPTIC TANKS ❑ SIGNATURE SE PITS) ❑ CESSPO LS ❑ OF PERMITTE p -. ®` /VjALIROBERT A. IC O Y..O.0. EN CASH SUPERVISING MECHANICAL ENGINEER LACo is 4 2 62 SEP 15 1 0 D 5 .0 0 T°A'"° ceeoe e.Bn APPLICATION FOR PER IT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION eU LDING JOHN A. LCou°IV EADDRESS SS °yl°°°c CAAT'1' D. GRIFFIN. N. Supt of Huildivg LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT N, OWNER BLOCK TRACT u MAIL ADDRESS 10.OF BLDGS. SIZE OF LOT NOW ON LOT CITY - TEL. NO. USE OF BUILDINGS DISTRICT(N]91. GROUP BK MAP PG 7PROCES BY CONTRACTOR O 7C ADDRESS.4-:/l.?/ CONNECTION DATA (f CI TEL.NO. T / TION O DEPTH STATE MANHOLE REFERENCE " E ER I REGISTRATION NO. COUNTY No. DESCRIPTIO OF RK FEE //�� /. HOUSE SEWER CONNECTING TO W{ PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM CZ SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL. DRYWELL @ 82.00 HOUSE SEWER CONNECTING TOP.C.NO. PRIVATE DISPOSAL SYSTEM @ SimCO.IMP. NO. JOB N0. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0. WORK TO HOUSE SEWER @ SLOO SEWS OR PAIR 0 FL SYSTEM HOUSE @ SL00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER CONNECT ADDITIONAL OWNERS AGENTIt e /4J OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(5) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR.SEWER OR HSEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR DISCDNNECT PLUG AND LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT M T EGAL OWNE OF THE ABOVE DESCRIBED RESID NTI ROPE WILL SEPTIC TANKS ❑ SIGNATURE S . P1T(S) ❑ CESS L5 OF PERMITTE G �VjALI T A. WOOD Qy j� y,.0. �o, ROES MECHANICAL SUPERVISING ENGINEER LPP 64272 SEP 151 1 D 2 5.0 0 r ` °` .. . 4 °' ' JBA642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. County Engineer ADDPE55 7 (O WILLIAM A. JENSEN. Sup't of Budding LOCALITY NEAREST FOR AP�PL^�ICANT TO FILL IN f CROSS BT. LEGAL ff�Yl 1� "I V DESCRIPTION L°TNO,/ ��aY3 OWNER C� MAIL ��,-I BLOCK TRACT ADDRESS (X/lael NO. OF BLDG5. SIZE OP LOT NOW ON LOT CITY TEL. NO. 7. I USE OF BUILDING$ '^ ' DISTRICT NO, GROUP I� MAP `CONTRACTORADDRESS CO CTION DATA STAT N N CITY TEL. NOSTATE REGISTRATION NO. ❑ COV NTY MqNHOLE REFERENCE NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P,L. M.L.TO P.L.PUBLIC SEWR55.00SEPTIC TANK,SEEPAGE PIT OR J ` NO O CO.IMP. NO. JOB NO.PITS AND/°R OFAINFIELO @ SIO.00 VHOO5E SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.PRIVATE DISPOSAL SYSTEM 43,00:71 ^CONNECT ADDITIONAL OLDG.OR AFFIDAVIT MV 1rRLx RECORD. INSTR_NO. WORK TO HOUSE SEWER C 43.00 OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN_CESEPOOL.ORYWELL.MANHOLE C� 55,0° GL ALTER,REPAIR ON ABANDON HOUSE HWY,OR ST,WIDENING ' S EWER OR DISPOSgL SYSTEM ® $300 STATE ENCROACHMENT L PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES ONERS PERMIT s 1 2 OD W AUTHORIZATION TOTAL FEE ,S 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 APPROVALS DATE INSPECTOR'S SIGNgTURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF-19— OWNER F19_OWNER OR NEW HOUSE SEWER J / OWNERS AGENT CONNECT ADDITIONAL ✓�/�/y� 4/ Y ADDRESS BUILDING OR WORK SEPTIC TANK.S EEP.PITIS) / HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ElDRYW ELL ❑ PLUMBING AND SEWERS. 1HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER.REPAIF,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY ANO STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABOVE DESCRIBED RESIDEN ACPWOPERTY. ABANDON HOUSE SEWER SIGNATURE {I\l\\//,YYI////(�/�l.X� BACK PERMITTEEFILL SEPTIC TANKS ❑ OF ❑ SEEP.PIT(S) LICESSPOOLS cJ ALIDATION ROBERT A. WOOD M,0, CASH SUPERVISING MECHANICAL ENGINEER LY,LO 5 8 4 2z I40V 13 1 0 D 5.0 0