Loading...
HomeMy Public PortalAbout9808 BROADWAY_Sewer__ .a D 0&EAPPLICATION FOR PERMIT 0�DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer _ County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT 0. GRIFFIN. SUPTOF BUILDING LOCALITY FOR APPLICANT TO FILL IN CEASE sT. LEGAL .J OWNER , _DESCRIPTION LOT NO. MAIL BLOCK TRACT J 7 ¢O� ADDRESS J(R0.OF BLDGS. CITY TEL. N0. SIZE OF LOT NOW ON LOT USE OF P DISTRICT NO. GROUP MAP BUILD RIGS - r rBK PG CONTRACTOR CONNECTION DATA c ADDRESS I� / / STATION /T. DEPTH O CITY TEL. N0. -� /D MANHOLE REFERENCE ry�= UPPRR ��O/ ®SATE TS LOWER NO REGISTRATIO . '�( / ❑ COUNTY NO. DESCRIPTION O IRK FEE HOUSE SEWER CONNECTING TO Y TYPE OF C RB CTIONPL LENGTH PROM ef _PUBLIC SEWER @ $3.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ S 3.00 ^^ �'7 OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. N0. IIX / JOB NO, O EXTN.,CESS POOL.DRYW ELL,MANHOLE a' $2.00 ) HOUSE SEWER CONNECTING TO �y z) PRIVATE DISPOSAL SYSTEM © $1.00 TRUNK PERMIT N0, ROAD PERMIT NO. c / CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Ca' $I.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNERS PERMIT E 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE '0 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. ' APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONN T E ABOVE DESCRIBED EXISTIN4 DWELLING TO THE PUBLI SE NEW HOUSE SEWER — SIGNED THIS QDAY OF1 ]�._Z CONNECT ADDITIONAL OWNER OR � BUILDING OR WORK OWNERS AGENT - SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEP Y ACKNOWLEDGE THAT 1 HAVE D THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORREC D 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND . LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE —�—� q DESCRIBED REBID npn�Tl(l �P�11PL1...1' Qf i �1 SEEP.RACKFPIT(SIP❑ CEESPANK00❑LS I ,lA i -Off SIGNATURE T_ V Vt t1111V tlIUW CO.V OF PERMITTEE I JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. Y.0. CAS- p !1�Co 1 7 s auc 2 8 4. 450