HomeMy Public PortalAbout8632 LONGDEN AVE_Sewer__ .!
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S&E-663 12.54 APPI C A T�® ..,F O PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING O 6
WM.J. FOX. COUNTY ENGINEER ADDRESS �V
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY ; /
FOR P LICANT TO FILL NEAREST C,
CROSS ST. .
LEGAL
DESCRIPTION LOT N0. _ OWNER � �•� L�� tj I s/
BLOCK TRACT MAIL EEESSS.��� 'moi✓
ADDRESS
l ®R NOWOON LOTS
SIZE OF LOT q.. � CITY TEL. NO.
USE OF
BUILDINGS DISTRICT N GROUP MAP PG
BK
CONTRACTOR - A/6 7
ADDRESS 71, CONNECTION DATA
CITY ' TEL. NO y STATION Y f� DEPTHLE
i
REG_ NI"I N 'I //•//•• CO UT TY 41. 11z• 1,4,6 &UPPER REFERENCE
f�T TYPE Of CONNEC LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CURB _ P.L. M.L.TO P.L. a'G
HOUSE SEWER CONNECTING TO c"]I
- PUBLIC SEWER - @ $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. Q/ JOB. NO.
_ 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/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
S PECIALCONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S S 1 00
AUTHORIZATION TOTAL FEE' REIMBURSEMENT FEE
I HAVE DATECON
TRACTORTHIS TO CONNECTO THE ABOVEWITH DESCRIBEDTHEH EREIN EXIISTINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE
SIGNED THIS DAY OF19_0
9 NEW HOUSE SEWER
' CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS
If SEPTIC TANK, SEEP, PIT(S)
ADDRPSS4(24_2�� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAV READ THIS APPLICATION CESSPOOL[IDRYWELL❑
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 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT. I AM THE LEGAL OWNER OF THE ABOVE -
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SES 411 �
��' CESSPOOLS %/• �{,Lyq�y,/
SIGNATURE .. -
OF PERMIT
WILLIAM J. FO ,!COUNTY ENGIN VALIDATION
®Y LAC
2B 5 0 4 FEB 3 4 4.J5 0 w
DEPUTY F ^DEPUTY
BY BY
�® DEPUTY DEPUTY.
'8&G420 11.55 � t�P P��V A T I®Il V Il ®R PE 11 LL W V/D 0 T ..
DIVISION OF BUILDING ARID SAFETY SEWER-SEWAGE D O S POSH L
Department of County Engineer ,•: g
County of Los Angeles BUILDINGVa
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
T) CASSATT D.-GRIFFIN, SUP'T OF BUILDING - LOCALITY
NEARE-:.... _
FOR' APP CANT TO FILL IN sr.
LEGAL- -
DESCRIPTIO LOT NO. yr / OWNER
'tMAIL
BLOCK TRACT `7 l ADDRESS -
/'
NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT V/ NOW ON LOTy
USE OF .•���
BUILDINGS ® DISTRICT NO. GROUP MAP
. /'�
BKG
• CONTRACTOR Y�
® 't CONNECTION DATA
ADDRESS /0 /
STATION _ DEPTH
TEL. N0.
CITY 7
/ d MANHOLE REFER EUPPER
_
LOWER
REGISTRATION NO. 7/ [I COUNTYaawY
No. DESCRIPTION OF WORK FEE r®
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD O•
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 - TRUNK PERMI AD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE E40frOACHMENT
WORK TO HOUSE SEWER @ $1.00 �8- PERM 0.
ALTER,REPAIR OR ABANDON HOUSE - IN STRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
r
CHARGES
CONNECTION CHARGE FEE '
OWNER'S PERMIT $ 1 00
_ REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE Q U
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO'CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. I SEWER. NEW HOUSE SEWER
SIGNED THIS DA ���1 ° CONNECT ADDITIONAL 40 Q
OWNER OR JUILDING OR WORK
OWNERS AGE T SEPTIC TANK,SEEP,PIT(S) t
ADDRESS 11/® AND/OR DRAINFIELD
t I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A LICATION :
:. 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 DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM-PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS AN LES COUNTY AND STATE OF '. ABANDON HOUSE SEWER
CALIFORNIA OR. THAT THE OWNER OF THE ABOVE
DESCRIBED RESIDENTI ER BACKFILL SEPTIC TANKS❑
SEEP. PIS) ❑ CESSPOOLS❑
SIGNATURE T ,
OF PERMITTEE
JOHN A. LAMBIE. :...;.
COUNTY E GINEER ROBERT A. WOOD,CHIEF PLBG. INSPECTOR
&ALIDATION
M.0. CASH - -
E-.AC0 3 9 5 S u NOV 1 4 2.0 0 M