HomeMy Public PortalAbout8752 LONGDEN AVE_Sewer__ -8�5
76A6423-6X
� APPLICATION F PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FUI IN CROSS ST.
LEGAL ' OWNER
DESCRIPTION LOT NO JrS of e
BLOCK TRACT MAIL
ADDRESS
140.OF BLDGS.
SIZE OF,IW T N W ON LOT CITY TEL. N 6�
USE DI CSI' DISTRICT 0. GROUP MAP PROCESSPD BY
BUILDI G I
BK PG 1
CONTRACTO
ADDRESh CONNECTION DATA
CI a TELL.NO. �a STATION O O DEPTH J
�r COUNTY 19 STATE MANHOLE REFERENCE
REGISTRATION N0. L yy
NO. DESCRI T NOF RK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $8,00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR '
Y. CURB P.L.- M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $8.00
OVERFLOW SEEPAGE PIT,DRAINFIELD 0.
EXTN..CESSPOOL.DRYWELL @ $2.00 _
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. N0. 0 JOB NO. U
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO w
WORK TO HOUSE SEWER $1.00
ALTER�OR DAIR OR ABANDON SAL SYSTEM HOUSE $1 00 STATE ENCR CHMENT O
4 Ica) PERMIT NO. U
NDUSTRI
1
ASTE AP OVAL / IV)
IL
OWNEk91v PERMIT $ 00 CONNECTION RGE FEE
AUTHORIZATION ITOTAL FEE REIMBURSEMENT FEE i
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
tv—
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSP€CTOR'S SIGNATURE
TO THE PUBLIC SEWER. g ,
SIGNED THIS D OF- 19_ NEW HOUSE SEWER VJ
OWNER OR CONNECT ADDITIONAL
OWNERS AfiEN7Irv- BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(3)
AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT I' HAVE READ THIS APPLICATION
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 ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER a
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEWL PROPPRTYBACKFILL SEPTIC TANKS ❑
SIGNATURE j�� SEEP.PITS ❑ CESSPOOLS
OF PERMITTE
VALIDATION ROBERT A. WOOD
CK. M.0. CASH/ SUPERVISING MECHANICAL ENGINEER