HomeMy Public PortalAbout9701 BROADWAY_Sewer__ DEPAIVrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY 4jW11 PPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING n v
ADDRESS
N LOCALITY
/ (�I'ES� (CANT TO FILL I �C
BUILDING r.- �9� NEAREST��
'ADDRESS' 110 / �A{�Q l�`-/�L.'�ry CROSS ST
LOCALITY .[:I/, / -�, �/ �. DISTRICT SERIAL NO. PERMIT NO. CC
NEAREST __ /y A //�r 3
CROSS ST.��-+!L� ';// L'L'•('_'_j _ /�/J
- RECEIVED BYa Ready for IRsoectlon -DATy ISSU EDf
OWNERMAIL
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ADDRESS 974'_9�• b�.c'L'X�0)Ll>l!I-�/ SE ZO NEf OCCUPANCY BK PG
CITY q TEL.NO. g— i46r /3
CONTRACTOR lilsgl'I�p� /�' t� [ i] •CO.IMP. NO. /Z 7(p
ADDRESS '?,/V L ,-�J ff-/F/ L- ��{5.��. JOB NO.
CITY /f\G= ,� /ry' /TEL.NO/�/n�. ��/ J �,. TRUNK PERMIT NO.
REGISTRATION N0. �f(s J jam' ❑ COUNTY ROAD PERMIT NO.
LEGAL r YA,t i,('F Fh' fH -�.j' • STATE ENCROACHMENT
DESCRIPTION LOT N0.' KAJ* ` PERMIT NO.
BLOCK - TRACT /biJsl/�'d l,��C(V Cs� �" INDUSTRIAL
WASTE APPROVAL
SIZE-OF LOT GI ✓24-.3 NOW ON LOTS
y!' ,� CHA ES
USE OF
BUILDINGS i2^ E.=L./pfL�l CONNECTION CHARGE EE
NO. DESCRIPTION OF WORK FEE '
REIMBURSEMENT FEE -
HOUSE SEWER CONNECTING TO
PUBLIC
PUBLIC SEW ER @ S 3.50 RECEIPT NO. /I 'GATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR p EXCEPTION RECORDED
WORKTO HOUSE SEWER 1.00 4" ��
K ALTER OR REPAIR EXISTING NO- I DATE IBY
SEWER OR DISPOSAL SYSTEM 1.00 _
'DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM LDO CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR /-- �� ,� /
PITSAN D/OR GRAINFIELD 2.00 STATION J DEPTH
CESSPOOL–DRYWELL `
SPECIAL CONDITIONS ONLY 2.00 / �UPPE 44FERE NCE ZO j�LDWER'
TYPE OF��OHM€CTION LENGTH FROM''/
OWNERS PERMIT $ j O0_' (CURBJ -,C:L't, M.L.TO P.L. ,� Z
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER-.
SIGNED THIS.....,N(. DAY OF /' :5=.'.----------_..._..... 19:,1_:: NEW HOUSE SEWER
/ CONNECT ADDITIONALOWNER OR 7 DUILDINGORWORKOWNEflS AGENT_...:.... T fr .._..........___......._
SEPTIC TANK.SEEP.PIT(S)
AOOflE55_........x 7/.G.�.... :f::L2,t=_E:C[,Zka.'.._l.®--.--.____
.-- ANO/OR GRAINFIELD
HEREBY ACKNOWLEDGE THAT FHAVE READTHISAPPLI- CESSPOOL[:] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I' HEREBY CERTIFY THAT I AM PROPERLY REGISTERED '
AND/OR LICENSED AS REQUIRED BY-LOS ANGELES COUNTY AND
, DISCONNECT PLUG ABANDON HOUSE ANO STATE OF CALIF NIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE�E RIBEO REWER
ESIDENT ALPROPF,RTY. BACKFILL SEPTIC TANKS
.SEEP.PIT(S)0 CESSPOOLS[R-1A Q /1-aa- S3
SIGNATURE r >. (./ �/
OF PERMfTTEE.__.. __!.'_2'......._._`..r t�...1: G ) � .
76A692A 663 7/53 ff
1/�
CE906 I0-63 APPLICATION OR PERMI
76A6420
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION Bm LOINc
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building T
LOCALITY / ,
NEAREST 11
FOR APPLICA T TO CROSS 5
EGAL
DESCRIPTION LOT NO.Z
/ • OWNE
M1 - 3� 71�,orliv Y MAIL
BLOCK TRnCT ADDRESS
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OFOISTfl ICT NO. GROUP MAP PROCESSED BY
BUILDINGS / — PG
CONTRACTOR Q_ ✓ �! Y G� /,3 i
ADDREss C 111 CONNECTION DATA
STATION DEPTH
CITY E
ATE UPPER
MANHOLE REFERENCE
REGISTRATION NO. CONNTY LOWER
NO. DESCRIPTION OF WORK FEE TY E CONNE TION LENGTH FROM
MOUSE SEW ER CONNECTING TO QU P,L. M.L.TO P.L.
PV BLIC SEW ER ® 55.00
SEPTIC TANK.SEEPAGE PIT OR O
PITS ANO/OR DRAINFIELD ® SIO.00 Co,IMP.NO. JOB
NO. V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, W
PRIVATE DISPOSAL SYSTEM a $3.00 0
CONNECT ADDITIONAL BLOC-OR
AFFIDAVIT MY 15[N[Xi RECORD, INSTR. NO. ATE U
WORK TO HOUSE SEWER ® $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD W
EXTN,.CESSPOOL.DRYWELL.MANHOLE 0 55.00 d
ALTER. HOUSE HWY.OR ST.WIDENING Z
SEWEq O M $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s 2 00
AUTHORIZATION I TOTAL FEE � � CONNEC N 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 INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNEROR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING ORRWORK WORN
ADDRESS SEPTIC TANK,SEEP.PIT(s)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ t
I REFER CERTIFY THAT AM PROPERLY REGISTERED AN /OR ALTER.R.W.SEWER OR
LICENSED AS REQUIRED LOS ANGLES COV NTY AND STA OF SEWAGED ISPOSAL.S_YS_TEM
CALIFORNIA Ofl TH AM HE LEGAL OWNER OF, O IN NO TO p
RESIDE IN, THE E S.,IBE. FESID IAL P up.
DISCONNECT PLUG AND I
ABANDON HOUSE SEWER
SIGNATURE BACK FIL LSEPTICTANKS ❑
OF PERMITTE ❑
SEEP,PIT(5) El CESSPOOLS
VALIDATION— ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. C45H
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