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HomeMy Public PortalAbout9715 BROADWAY_Sewer__ E 5& -6642D3 II�SS APPLICATION FOR PERMIT 5 e 6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS © CASSATT O. GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN LROSSST.LEGAL DE CRIPTION LOT NO.A!5 O VJ �0fVi x OWNER BLOCK TRACT MAIL 'gaDDRESB C N0. OF BLDGS. CITY NO. TEL. SIZE OF LOT �� NOW ON LOT y USE OF BUILDINGS DISTRICT NO. GROUP MAP \ 7 BK PG CONTRACTOR51 aDDREss Yl�yy �,. u�` Gab• CONNECTION DATA CITY - SY S. TEL. NO.Q' STATION DEPTH MANHOLE REFERENC UPPER _ -/ / ❑ STATE LOWER REGISTRATION NO. 9 y 176 `" Z�' ❑ COUNTY 0 ga No. DESCRIPTION OF WORK FEE G� TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $3.50 HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L. TO P,L. _ SEPTIC TANK,SEEPAGE PIT OR , fs` PITS AND/09 DRAINFIELD _ Q $3.00 �j �i 1► OVERFLOW SEEPAGE PIT, DRAINFIELD CO, IMP. NO. J ( ( 6 P. NO. EXTN..CESSPOOL,DRYWELL,MANHOLE Q $2.00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROA/PERMIT NO. fCONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER $1.00 O PERMIT N0. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM $1.00 WASTE APPROVAL 00 CHARGES _ CONNECTION CHARGE FEE OWNER'S PERMIT S t 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RMA CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS DAY OF 79 CONNECT ADDITIONAL is OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I 'M PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED REQUIRED BY LOS ELES CO TY AND STATE OF ABANDON HOUSE SEWER CALIFO Ip OR THAT 1 AM T E-LEG L OW ER OF TH ABOVE _ DESC EOR IDENTIAL PROP TY. BACKFILL SEPTIC TANKS Cl SIG T SEEP. PIT(S) ❑ CESSPOOLS❑ OF R T JOHN A. LAM IE. COUNTY ENGINEERALIDATIONi1 ROBERT A. WOOD. CHIEF PLBG. INSPECTOR CK. N. D. ASR 6 9 6 u; NVIR 2 4 2.0 0