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Home My Public Portal About9669 BROADWAY_Sewer__ CESOS 8.50 APPLICATION FOR PERMIT �( � CEp08 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION eul LolnG JOHN A. LAMIE, Cpu¢tF E.,i. neer ADDRESS CASSATT D. GRIFFIN, Supt of Rnildi¢q LOCALITY NEARESTOi FOR APPLICANT TO FI IN CROSS ST. LEGAL DESCRIPTION LOT ND. Lt I OWNER BLDCK TRACMAIL 6 ADDRESS NO.OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS I DISTRI T NO GROUPI MAP I PROCESSrp BY CONTRACT ` o .[= P `y ADDRESS 1 CONNECTION DATA CI TEL.N0. Q AT ON DEPTH /^�rj� TATE A HOLE REFERENCE UPPE _ REGISTRATION NO Z[ aC COUNTY No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO `� - @ PUBLIC SEWER $3.00 TYPE OF CONNECTION LENGTH FROM ('A'• SEPTIC TANK,SEEPAGE PIT OR - YCURB PLM.L. TO P.L. E_ PITS AND/OR DRAINFIELD @ 53.00 Y. P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP.C.N0. PRIVATE DISPOSAL SYSTEM @ E1.00 CO.IMP. N0. JOB NO. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ SLOG TRUNK PERMIT N0. ROAD PERMIT NO. r ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWEROR D ISPOSAL SYSTE M @ $1.00 PERMITNO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S Q OO 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 q2/ n 'lhrtLf..L.:O/ OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(5) AND/OR DRAINFIELD I HEBERT 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 ALTER,REPAIR.SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM T LEGAL OWNE F THE ABOVE DESCRIBED REBID NTI ROP Y BACKFILL SEPTIC TANKS ❑ SIGNATURE SEE PITIS Cl CESSPOOLS ❑ OF PERMITTE ®` VALMATION ROBERT A. WOOD M.9. GSH SUPERVISING MECHANICAL ENGINEER - LU,D642ECR SEP '151 0 D 5.00 ' ~ APPLICATION FOR�IT ';-' � 9 >eABreD CEBOS a-SB COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADDLDING ESS Bm R JOHN A. LAMBIE, County. Engineer RESS CASSATT D. GRIFFIN. Sup t of Building LOCA Lilt• NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL f DESCRIPTION LOT N0. lZ;ja_(2_ OWNER BLOCK TRACT MAIL ADDRESS DF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL.-NO. USE OF BUILDINGS ` io GR I EBK MAP PG I PROL CONTRACTOR / (/jl(e f ADDRESS " CONNECTION DATA CI TEL.NO. / IDN .S, DEPTH �. I L ESTRATION N0, STATE MANHOLE REFERENCE . PPER RGICOUNTY - !J i rvo. DESCRIPTI N OF WORK FEE e HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 SEPTIC TANK,SEEPAGE PIT OR TYPE OF C NI ECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L. 1. OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN..CESSPOOL. DRYWELL @ 52.00 HOUSE SEWER CONNECTING TO P.C.NO, PRIVATE DISPOSAL SYSTEM @ SLOO CO.IMP. NO. JOB NO. CONNECT ADDITIONAL BLDG.OR - WORK TO HOUSE SEWER @S1.00 TRUNK PERMIT N0. ROAD PERMIT NO./ZA15 ALT ,'REPAIR OR ABANDON HOUSE PERMIT N O. ENCROACHMENT SE 0 D SAL SYSTEM @_51.00 STATE N INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE6 C�(7' REI MOURSEMENT 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 OqF I9_ NEW HOUSE SEWER OWNER A OWNERS AGENT " v/X� CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 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 ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRE p LOS ANGELES COUNTY ApVOj STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT M THE 4GA WNER f HE ABOVE DESCRIBED REST NTI ROPE SACKFIL ISEP❑C CTANKS ES POIOL - SIGNATURE OF PERMITTE ®" ALIDATION ROBERT A. WOOD - CIc Y.0. GASH SUPERVISING MECJHANICAL ENGINEER LAC o 4 2 9— SEP 1 5 1 1 0 -2 5 .0 0