HomeMy Public PortalAbout8748 LONGDEN AVE_Sewer__ +0-63
76A642D APPLICATION FOR PERMIT
6A64
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Eng neer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN
CROSS 5T 4cr"'
LEGAL
DESCRIPTION LOT NO f OWNER >- - R►
MAIL
BLOCK TRACT ADORES
NOOF BL GS
SIZE OF LOT NOW ON LOT TEL NO
USE OF fj DISTRICT GROUP MAP PROCESSED BY
BUILDINGS BK PG
�.
CONTRACTOR
DRESS CONNECTION DATA
I TEL NO V STATION DEPTH
ATE MANHOLE REFERENCE �
REGISTRA 1 N NO ❑ COUNTY LOWER
NO SCRIPTION tF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L
PUBLIC SEWER @ $5 00
13-
SEPTIC TANK SEEPAGE PIT OR P C NO O
CO IMP NO .108 NO
PITS AND/OR DRAINFIELD @ S1000 V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ S3 00 ^
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVED EASEMENT RECORD INSTR NO DATE 0
WORK TO HOUSE SEWER @ $3 00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD lJJ
EXTN CESSPOOL,DRYWELL MANHOLE @ $5 00
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT z
I PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT S 21 Oo CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWS APPROVALS DATE INSPECTOR'S SIGNWRE
SIGNED THIS DAY F I oe
f//
OWNER OR NEW HOUSE SEWER
OWNERS AGENT NNECT ADDITIONAL
ILDING OR WORK
ADDRESS
SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE TH I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE
NCORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANmES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE GAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, ROVE C�.+6R RESIDENIIAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE 'BACKFILL SEPTIC TANKS ❑
OF PERMITTEE , SEEP PIT(S) ❑ CESSPOOLS 01 1
VALIDATION ROBERT WOOD
CK M o CASH SUPERVISING MECHANICAL ENGINEER
Lr��,�4 5 9 3:d OCT 6 2 0 ;1 7.0 0-