HomeMy Public PortalAbout9902 BROADWAY_Sewer__ 9 - APPLICATION FOR PERMIT 1
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9a DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depoxtment of County Engineer
County of Los Angeles BUILDING
.JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT or BUamNcJ
LOCALITY /7��.�� o1_1NEAREST
FOR APPLICANT TO FILL IN CROSS STLEG .
DES RI PTION LOT N0. -��} OWNER
BLOCK TRACT MAIL�� ADDRESS
NO. OF BLOCS. CITY TEL. NO.
SIZE OF LOT Q NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS C
T BK PG
CONTRACTOR �� O /
ADDRESS `� — �J //^^ JC/ NE
ONCTION DATA �•
CIT - �/e CV EL. NO. STATION /J�j J r DEPTH !9
,fMANHOLE REFERENCE UPPER
REGISTRATION NO. O•�' ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ S 3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFI ELD CO. IMP. N0. � Z 7 4 10B No.
O.
EXTN.,CESSPOOL,DRYWFLL.M AN HOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
/ CONNECT ADDITIONAL BLDG.OR ST ATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 OO PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
TOTAL FEE REIMBURSEMENT FEE
AUTHORIZATION
i HAVE AT THIS GATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCR D EXISTING DWELLING
TO THE PUBLIC SEWE '/may// NEW HOUSE SEWER
SIGNED THIS DeA}/...�y////�''O'''''''T7, Igo , CONNECT ADDITIONAL c
OWNER OR lv BUILDING OR WORK J
OWNERS AGENT l SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR GRAINFIELD
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 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 M THE LEGAL NER OF THE ABOVE
DESCRIBED RESIDENT L P PERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP,PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD:CHIEF PLBG. INSPECTOR
C%. U.0. PSH
(AC 5 3 1 1 FEB 19 4 2.0 D in
D
5 a E-6 S420 I I-e5 APPLICATION FOR PERMIT 1
e&
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dep. ent of County Engineer
County of Los Angeles BADDRESS
UILDING
JOHN A. LAMBIE, COUNTY ENGINEER
® CASSATT O. GRIFFIN, SUPT DF SUILDIrvc
FOR APPLICANT TO FILL IN caoss si.
LEGAL
DESCRIPTION LOT NO. _j -..5r OWNER , 22 jpQ
BLOCK TRACT Q CiD � MAIL
ADDRESS
512E OF LOT 5";? / NO. ON LOT
OF BLDGO
��) NOW . CITY TEL. N0.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
/J/' / / },/ BOK PG
CONTRACTOR'O,5?g �Jy//� /� e• _1�
ADDRESS,_!d,¢Q ��j�/�� �y,o / � CONNNECTION DATA
STATION (� T �S- DEPTH (J
CITY �� E/L. N0. ,fig •) 145 LOW Eft
MANHOLE REFERENCE
T
REGISTRATION NO.
/ Qy� S'- ❑ COUNTY /
.NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OFC CTION LENGTH FROM /
/ Y. P.P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50 Q s
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ §3.00
OVERFLOW SEEPAGE PIT. DRAINFIELDMANHOLE
HOCO. IMP. NO. '/ [r/ lOB 'N
OO.
OW SEEPAGE
YWELN LE @ §2.00 /
HOUSE SEWER CONNECTING TOA
PRIVATE DISPOSAL SYSTEM @ S1.00 TRUNK PERMIT NO. ROAD PERMIT NO.&2
0
CONNECT ADDITIONAL SLOG,OR - STATE ENCROACHMENT
WORK TO HOUSE SEWER @ §1.00 PERMIT NO.
ALTER, REPAIR OR ABANDON HOUSEINDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
_ CONNECTION CHARGE FEE
OWNER'S PERMIT S t 00
AUTHORIZATION TOTAL FEE �N. REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED LONG APPROVALS DATE INSP CTOR'SSIGNATURE
TRACTOR TO CONN CT T C-ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC� W R. NEV! HOUSE SEWER
�
SIGNED THIS AY _19r« CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREB KNOWLEDGE THAT 1 HgVE READ HIS AP LIGATION CESSPOOL❑ DRYW ELL❑
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR AND
PLUG 0
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT CT PLUGHOUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ER A
DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS L'.
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIOIJ ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. X.0. CASH
LACO5201-� FEB 15 4 4.50 in
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