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Home My Public Portal About8758 LONGDEN AVE_Sewer__ 76A642.62 A APPLICATION FO® PERMIT 76A 642D /� 1 V I� R COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS 1/a WILLIAM A. JENSEN, Supt of BuildingLOCALITYNEARESTFOR APPLICANT TO FILL IN `ROSS ST.LEGALDESCRIPTION LOT NO. /, . OWNERMAIL BLOCK � � TQ... P' ADDRESS NO. OF BLDGS. �ySIZE OF LOT ^ pNOW ON LOT / CITY "'��jyQ � L. NO. '7'�"/ USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR rA ,� �� ADDRESS CONNECTI N DATA STATION �� DEPTH CITY TEL. NO. _ ❑ STATE MANHOLE REFER CEPER REGISTRATION NO. ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNEC ON LENGTH FRO HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P. (pl' PUBLIC SEWER @ $5.00 SEPTIC TANK.SEEPAGE PIT O R P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP,NO. J NOB NO. C� HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. OAD RM IT NO. I PRIVATE DISPOSAL SYSTEM @ $3.00IT CONNECT ADDITIONAL BLDG.OR AFFIDAVWAIVER EASEMENT RECO .INSTR. NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD (off EXTN..CESSPOOL,DRYWELL,MANHOLE @ $5.00 HWY.OR ST.WIDENING A�R-01tABANDON HOUSE =5'S6YGL�6R DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ z 00 CHARGES AUTHORIZATION TOTAL FEE C__e) CONNECTION HARGE FEE ITHAVE AT THIS DATE A CONTRACT WIH THE HEREIN NAMED CON, REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I P HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 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 ABO RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS T ❑ ,},f�` �/ 9 ` 41 OF PERMITTEE SEEP.PIS) ❑ CESSPOOLS u"' A VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER 6A642- 7 D 62 APPLICATION FOR 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, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FIL IN CR ST. LEGAL DESCRIPTION LOT NO. /1 ` OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY !EL. O. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR ADDRESS Q (� C/�ONNECTION DATA CITY TEL. NO. /3 •(•� STATION / DEPTH ❑ ST TE MANHOLE REFERENCE �J�- UPPER REGISTRATION NO. ❑ COUNTY _ NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIONP.L. M.L.TO P.L.LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB pno PUBLIC SEWER, @ $5.00 -if P.C.NO. SEPTIC TANK.SEEPAGE PIT OR CO.IMP.NO. JOB NO. PITS AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR,NO, DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING _ SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ JS Oo AUTHORIZATION TOTAL FEE �� CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREICON- REIMBURSEMENT FETRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTELLINGTO THE PUBLICSEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_OWNER OR NEW HOUSE SEWER p AOWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESSSEPTIC TANK.SEEP,PITS) HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGROMPLYWITH ALL COUNTY ORDINANCES AND STATE LAWLATINGPLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTND�OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY TE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESURIBE RESIDENTIAL PPP/RRABANDON HOUSE SEWER � V SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ SEEP.PITfS) ❑ CESSPOOLS VALIDATION ROBERT WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH ' i� 1 l7 �• .