HomeMy Public PortalAbout8606 LONGDEN AVE_Sewer__ FL-6D
S& 89 9-SS APPLICATION- FOR PERMIT 1
8 @ H•8
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
WM.J. FOX,COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OR BUILDING LOCALITY
-FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT N0. OWNER
BLOCK TRACT MAIL
ADDRESS
NO. OF BLDGS.
SIZE'OF LOT NOW ON LOT CITY ..- TEL. NO.
USE OF `
BUILDINGS - DISTRICT N0. GROUP MAP
BK
CONTRACTOR
ADDRESS , ONNECTION DATA
C6T:Yf'-wi. ,�y� TEL. NO. STATION DEPTH
1/7 ❑ STATE MANHOLE REFERENCE L ,T/ UPPER
REGISTRATION NO. ❑ COUNTY IT �•� �d� �'�'�
NO. DESCRIPTION OF WORK FEE
Q TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO P`� Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER Q $ 3.50 a_,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0. ��y JOB
N10
O
WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT '
AND/CR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CH ES
PERMIT CONNECTION CHARGE FEE
OWNER'S 5 1 00
AUTHORIZATION TOTAL FEE +C�.C 1 ,J REIMBURSEMENT FEE
TRACTORHAVE TTO CONNE THIS DATE ONTRTHEAABOVE DESCRIBED EXCTED WITH THE ISTINGIN /A(DWELLIED NG APP1ROi/ALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER _
SIGNED THISDAY OF APoT/U� c7-1q f4 NEW HOUSE SEWER pI,
OWNER OR Rif
i f 1 9i/ ���E� Al
CONNECT ADDITIONAL '/
OWNERS AGENT V' [[[ VCLe� t.A' " BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL E3 DRYWELL ElAND 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 1 AM PROPERLY REGISTERED AND/OR-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR'THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPV,,'
17TI
BACKFILL SEPC TANKS❑
SEEP.PIT(S) CESSPOOLS❑
SIGNATURE r•,
smarmsmolm
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
_ �T6572S AUG 12 4.50
APPLICATION FORPERMIT
6
08 2/70
76A 6A 642DD
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
NG
JOHN A. LAMBIE, COUNTY ENGINEER . ,1 /
11
COLEMAN W. JENKINS. SUP T OF BUILDING
TY v
FOR APPLICANT TO FILL IN
(PRINT OR TYPE ONLY) ST
LEGAL
DESCRIPTION LOT NO 2 OWNER ,q
ON MAIL
BLOCK TRACT ADDRESS If/�� 6 lam// Aw
SIZE OF LOT NOW OONB LOTSI
CITY �j�"�L/� TEL. NO.
USE OF
BUILDINGS Ar�.� ` DISTRICT NO GROUP CLASS MAP PROCESSED BY
�/SID// // ���a+�, �n��
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL. NO STATION
STATE LIC 1 r— UPPER
LICENSE NO. CLASS MANHOLE REFERENCE
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTI N LENGTH FRO
HOUSE SEWER CONNECTING TO Y. CURB P L. M L.TO P L
PUBLIC SEWER 0 fS 00
SEPTIC TANK SEEPAGE PIT OR P C.NO
PITS AND/OR DRAINFIELD @ f1000 CO IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $3.00 d
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIY[n '[AS[M[XT RECORD INSTR NO DATE O
WORK TO HOUSE SEWER @ $300 (J
OVERFLOW SEEPAGE PIT.DRAINFIELD '
E XTN CESSPOOL,D MANHOLE fS.00
ABANDON
HWY OR ST WIDENING
+moi-ABANDON HOUSE O
SEWER 052=W08B'hL SYSTEM $3 00 STATE ENCROACHMENT V L)
PERMIT NO W
INDUSTRIAL IZ
N
WASTE APPROVAL _ Z
OWNERS PER f OO CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWE �L APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS // DAY OF !� 19.�
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS--M-lea Ix- BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY.REGISTERED AND/OR ALTER.REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL PRO ERTY. ABANDON HOUSE SEWER
SIGNATURE A" ❑ z
OF PERMTTTEE BACKFILLS C PTIC TANKS
EEP.PIT(S) ❑ CESSPOOLS ❑
VA DA ON JACK R. ALLEN
CK SUPERVISING MECHANICAL ENGINEER
s
.
167,� AUG 41 0 A 6.00-