HomeMy Public PortalAbout8637-8639 LONGDEN AVE_Sewer__ APPLICATION -�OR 'PERMI"T
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DIVISION 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 OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
LEGAL .71
p CROSS ST.
DESCRIPTION LOT NO. /1— 1,JS • 54!.5 FOVbg*1..� OWNER i
BLOCK TRACT /� /� rte„ L� MAIL
ADDRESS
— ��y,+ LDGS, j
SIZE OF LOT ) /S� LOT CITY TEL NO
USE OF
BUILDINGS CALIF. DISTRICT NO. GP MAP
CONTRACTOR CF �� I i-- BK PG
ADDRESS 1317 COLEGROVE AVS. CONNECTION DATA
CITY MONTEBELLO TEL. NO.PA. 1-5045 STATION,.77-
44 DEPTH
REGISTRATION NO.
148659 (STATE) ❑ STATE 7( Q P'wMANHHOOLSERREFERENCE
COUNTY LOWER
❑ / v''Y/'
TYPE OF CONNECTION LENGTH FROM '
NO. DESCRIPTION OF WORK FEE `y � $4 v P L. M L.TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ '3 50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG. OR CO. IMP.NO. 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 ,
P,TS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 200 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE f7 REIMBURSEMENT FEE
TRACTORHAVE T TOS CONNECTDATE ONTRTHEA ABOVECTED WDESCRBED EXISTINGITH THE HEREIN A DWELLING 101- APPROVALS DATE INSPECTOR SSIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAM OF 19 NEW HOUSE SEWER
L �
OWER OR CONNECT ADDITIONAL
OWNERS NT BUILDING OR WORK _
Q SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT Ii HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL[IAND 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKEII.JSfiPL4e-Frmna o
_9LP,-.'-"r•", CESSPOOLS I S
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
__AGO 7 2 3 3- AUG 2 9 4 4.5 0 In
BY BY — -
DEPUTY { DEPUTY
BY BY
® DEPUTY DEPUTY