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HomeMy Public PortalAbout8760 LONGDEN AVE_Sewer__ A42o CEe0e a-se APPUCc A MN FOR pGG�l�ii T ceCOUNTY OF LOS ANGELES o DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, Count? Engineer CASSATT D. GRIFFIN, Sup t of Building LOCALITY C ..... - r;.e.- .,... NEAREST °. FOR APPLICANT O FILL IN ceoss ST._ a.. LEGAL O OWNER DESCRIPTION LOT N0. BLOCK TRACT MAIL .� ©-� ADDRESS NO.OF BLDGS. "'>' SIZE OF LOT r NOW ON LOT ,.� CITY "� TEL. NO.USE OF _ r. 'P BUILDINGS -+° DISTRICTRNO. GROUPBK MAP PGo 1 PROCESS IBY �tCONTRACTORI I ADDRESS '17 jCONNECTION DATA CITY ftj� TEL.NO. _Q 1STATION DEPTH STATE MANHOLE REFERENCE PER REGISTRATIO NO. CS COUNTY )' / NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM d SEPTIC TANK,SEEPAGE PIT OR Y. CURB M.L. T P.L. 9 PITS AND/OR DRAINFIELD '@ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO /� P.C.NO. PRIVATE DISPOSAL SYSTEM @ $7.00 CO.IMP. NO. v JOB NO. CONNECT ADDITIONAL BLDG.OR µ WORKTO HOUSE SEWER @ $1.00 L/ TRUNK PERMIT N0. ROAD PERMIT N0. a SEWER OR PAIR OR RJVSAL SYSTEM HOUSE $1 00 PEATE E'I*C RMIT NO,OACHMENT d — B INDUSTRIAL WASTE APPROVAL ARGES OWNER'S PERMIT $ 2 00 CONNECTION CHA FEE AUTHORIZATION TOTAL FEE L) a REIMBURSEMENT FEE 5 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- T RACTOR ON-TRACTOR TO CONNECT THE ABOVE DESCRIBED EXI TING DWELLING ' APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SE SIGNED THIS DAY NEW HOUSE SEWER OWNER A ( , CONNECT ADDITIONAL ~\ OWNERS AGENT BUILDING OR WORK ADDRESS a SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD — I HEREBY ACKNOWLEDGE THAT I HAVE REP,THIS APPLICATION t AND STATE THAT THE ABOVE IS CORRECT14 - A 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 .i. ABANDON HOUSE SEWER CALIFORNIA OR THAT AM T _' HE EGAL OWNER OF THE ABOVE .- DESCRIBED RESIDE I L PROPERTY. BACKFILL SEPTIC TANKS ❑ . SIGNATURE o SEEP.PIT(S) ❑ CESSPOOLS ❑ /� ®v ALIDATION ROBERT A. WOOD CK M.0. CASH SUPERVISING MECHANICAL ENGINEER I DEPARTMENT oiF COSY ENGnvEm SEWER—SEWAGE DISPOSAL DIVISION' OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY- OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITYBUILD NG t-; NEAREST ADDREISS L O "• .��t . CROSS ST. /J� LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A ?30 S CROSS ST. RECEIVED BV_ Ready for Inspection DA E ISSU OWNER / ®"MAIL 4LA `%% DA ADDRESS(,/ USE ZONET OCCUPANCY BK M PG CITY ® TEL. 0. V CONTRACTOR X- a -211`4 lllA l t/1 >_ CO.IMP.N0. ADDRESS JOB.N0. CITY TELAO• G TRUNK PERMIT NO. REGISTRATION NO. / ® COUNTY ROAD PERMIT N0. LEGL DESCRIPTION LOT NO.xiS 4 STATE ENCROACHMENT g PERMIT NO. BLOCK — TRACT /O INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLDGS. NOW ON LOT CHARGES USE OF C+ BUILDINGS a.7 I CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIGSEWER Q S 3.50 RECEIPT NO. I DATE IBY HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO I DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM - 1.00 I CONNECTION DATA SEPTIC TANK,SEEPAGE PIT_OR C PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 Z OG MANHOLE REFERENCE iUPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ I 00 Y. CURB P.L. M.L.TO P.L. ' AUTHORIZATION TOTAL FEE ' O� I HAVE THIS DATE CONTRACTED WITH THE HEREIN-NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS---------------------DAY OF-----................................... 19-------- NEW•HOUSESEWER OWNER ORCONNECT ADDITIONAL OWNERS AGENT-----------------•-----•-------------•---------------• - - BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS...............-.................--•---------- ..............----------------•--- AND/OR DRAINFIELD n I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI•. CESSPOOL DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE. rd� TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED. DISCONNECT PLUG AND ANC/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY: ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ER OF THE ABOVE DESCRIBED �RESIOEN, AL P I'ERTY. BACKFILL SEPTIC TANKS I]SIGNATURE SEEP.PIT(S)E] CESSPOOLS�OF PERMITTEE____ - 76A642D 663 1/53