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Home My Public Portal About9704 BROADWAY_Sewer__ D C7SAeAE808 APPLICATION FOR PERMIT eeoe a-Da COUNTY OF LOS ANGELES 'T]' SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BuiLDING AND SAFETY DMSION - emLDING /,D MINIM A" LAM IE, CountF Engineer ADDRESS CASSATI' D. GRIFFIN. Supt of Building LOCALITY !� G NEAREST FOR APPLICANT TO Fnl IN cftoss sr. _ LEGAL DESCRIPTION LOT NO. OWNER MAIL y I BLOCK TRACT /� ADDRESS � I / l NO.OF SLOGS. -^�—' 'I SIZE OF LOT NOW ON LOT CITY ` TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAPP( ESSED / BK PG} I / CONTRACTOR L D ADDRESS / / CONNECTION DATA CITY q T /f EL.N0. � - IDN � L' �� DEPTH / 2 STATE M N LE REFERENCE C� PPER REGISTRATION N0. ��7 ✓D� COUNTY Q s P NO. 1 DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM C, A SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. c1 PITS PND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE T.DRAINFIELD f EXTN..CESSPOOL. DRYPIWE L L @ $2.00 HOUSE SEWER CONNECTING TOP.C.N0. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. oC JOB N0. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0. WORK TO HOUSE SEWER @ $1.00 SEWER REPAIR R DISPOSAL SYSTEM HOUSE @ $100 STATE ENCROACHMENT PERMIT N0. WASTH7RIAL A PFRO L I - 1 �_TY� OVMER PER $ '2 00 CONNECTION CHARGE FEE AUTHORIZATION TO L FEE 15- 60-0 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 OR CONNECT ADDITIONAL DWNERS AGENT 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 DISPR,SEWS OR EM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/Oft DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABAN CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DON HOUSE SEWER DESCRIBED RESIDENTIA OPERTY. BACKFILL SEPTIC TANKS [I S'c .PITS) ❑ CESSPOOLS ❑ SIGNATURE OF PERMITTE Or IrAUDATION ROBERT A. WOOD t K. M.0. CASH SUPERVISING MECHANICAL ENGINEER LAGo 7 8 1 4 5 MR 16 1 0 A 5.0 0 n x U CE1105 5 e�eo APPLICATION FOR PERMIT EBOB COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING .A, 'ADDRESSILDINO ])ONN A, LAMBIE. County Enq�nar CASSAl'f D. GRIFFIN, SuPt of Buil 1 LOCALITY •'X70 fi - - - - NEAREST FOR APPLICANT TO FHl IN CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER BLOCK TRAMAIL CT ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF ' BUILDINGS DISTRI CT NO.I GROUP IBK MAP PG I PROCESSED BY CONTRACTOR �) _ /H T`J �j / % ` ADDRESS`T CONNECTION DATA CITY'`/9 ��/1 TEL.NO. .. 0 DEPTH ESTATE MANHOLE REFERENCE{S r PPER FEE � + REGISTRATION N0. 7i CCOUNTY O ' , /f� NO. DESCRIPTION OF WORK FEEell el NOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR YCURB P.L. M.L.TO P.L. cC. PITS AND/OR DRAINFIELD @ S3.00 � ' OVERFLOW SEEPAGE T.DRAINFIELD ela EXTN..IESSPOOL.D RYT, WE LL @ $2.00 . HOUSE SEWER CONNECTING ToP.C.NO, PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. / / JOB N0. WORK TOTHOUSEISEWER CDG.OR @ SI.00 TRUNK PERMIT N0. ROAD PERMIT N .O�Sj^71 ALT ER.RE PAIR OR ABANDON HOUSE BT MENT SEW ER OR DISPOSAL SYSTEM @ $1.00 PE j 1 �� IN81)SiRTRC•" CHAFrGES OWNERS PERMIT g esu / AUTHORIZATION I TOTAL FEE p-O 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 OR CONNECT ADDITIONAL OWNERSAGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL D DRYWELL D WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALT PLUMBING AND SEWERS. ER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUG AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVEHOUSE + DESCRIBED RES[DENTI L PROPERTT. BACKFILL SEPTIC TANKS D SIGNATURE SEEP PITS D CESSPOOLS a. OF PERMITTEE-/ ®r —VALIDATION ROBERT A. WOOD a6 N.0. CAGB SUPERVISING MECHANICAL ENGINEER LACo 7 8 1 5 S neR 16 i 1 A 2 5.0 0 M