HomeMy Public PortalAbout8768 LONGDEN AVE_Sewer__ CEBOB 362
76A642D APPLICATION FOR PERMIT
BU LS
COUNTY OF LOS ANGELES EWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, County Engineer " ADDREss
WILLIAM A. JENSEN, Supt of Building
ITYt.
NEAREST
FOR APPLICANT TO FILL IN CROSS 5T.
LEGAL
DESCRIPTION LOT NO. OWNER
I MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITYTEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
IP-
'c"
CONTRACTOR
ADDRESS CONNECTION DATA
CITY EL. NO. STATION DEPTH
d�STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. �O ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $5.00
P.C.NO.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. U
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. �.
PRIVATE DISPOSAL SYSTEM @ S3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I 141VEI EASEMENT RECORD,INSTR.NO, DATE
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL.MANHOLE @ S5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING rD
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT •Z
PERMIT NO.
QO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 2 00 CHARGES
AUTHORIZATION TOTAL FEE 00 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 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 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
^ AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -
PLUMBING AND SEWERS. CESSPOOL [:1 DRYWELL ❑ n
I 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 {f 21�
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND IV
SIDE IN, THE ABOVE DESCRIBED RES A ENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE E]SEEP.PIT(S) ❑ CESSPOOLS
ALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
5 2 1 5 FEB 4 1 0 A 5.00-
ro
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nzPARTNENT OF C•OUNTr EPTGDrEZR SSR—SEWAGE DRSPOSAL
DIVISION OF BUILDrNG ARID sAFEETY PERMIT APPLICATION
COL'N-ry OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER I 8uI
DDRESSL E'28
AU r t... F t- hV C7•�%^ �'t
FOR APPLICANT TO FIL IN LOCALITY
_- o DUILDING / NEAREST
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ADORE89 ( L� CRORSIAT.
LOCALITY
DISTRICT NO, SERIAL 910. PTIM7.7 CAL, ;
.fi
; A I �i Z S
NEARET ��f
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CROSS ST. RECEIVED BY RonQg tcp 120000000 OAta r s8
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OWNER Cjm, p 7 J
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ZONEOCCUPANCY
7 SE
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CITY �psa./ v TEL.Ir� � ,�• .
-
.CONTRACTOR M. C. NOttingh3M Co Of T .(n I(j P�'.I Co
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AODR'-!.8 5933 N. --
CLOVERLY AVE, -- -
T JOB.q0,
ELq�! CALIF. .:
_ CITY TRUNK PERaIT PO.
/ Pl STATE
REOISTRAiiGw ii' g 1'-'1�COUNTY RnAD PERVIT 920. „7-3 170 _ -
LEGAL v / STATE ENCRC-C.MMENT r— I
DESCRIPTION LOT$40. 4J
PERMIT NO
IAL
BLOCK — TRACT U-"S "WASTE APPROVAL
NO.of BLOG
SIZE OF LOT f� b If 99 NOW ON LOTa CHARGES
USE OF nn CONNECTION CHARGE FEE —
BUILDINGS
N0. I DESCRIPTION OF W K
—1 FEE — _ REIgBURSEISERTFEE 4,
nvvos ii CONNECTING TO
aewe1
PUBLIC SEWERHa 9 1.50 '� 1�� RECEIPT NO. - OAT; Y
,
o
IOUSE HEWER CONNECTING TO AO
r
PRIVATE DISPOSAL SYSTEM IAO--7-
I don-REC" EXCEPTION RECORDED
DD(tlOwAl Atnr, OR
W2!tX TO 4^L18E SEWER I•CD NO. I DATE 18Y
ALTER OR REPAIR EXISTING -
_LSEWER OR DISPOSAL SYSTEM
Of
--
DISCONNECT AND AB4NDON SEWER CONNECTION DATA
ANO/0R DISPOSAL SYSTEM _ 1.00 1 '
j SEPTIC TAaK.SEEPASE PIT OR = 1 B�A�QU r, _ ` DEPT
_ iPITS AND/ORORAINFIELD
CESSPOOL—ORYWCLL
MANHOLE REFERENCE L
�£CIAL C iGiiS 0NLY ?q ' I ') /^ UPPER
^ --
r TYPE OF OnRNECTIOR LEMSTW FROG
Y. CURB ✓ P.L.— M.L.TO P.L.
o —T -
g AUTHORIZATION TOTAL FEE
I PAVE THIS DATE CONTRACTED WITH THE HEREIN KAEl£E
CONTRACTOR TO CONNECT THE ABOVE DESCRIS£D EXIST103 APPROVALS INtiPECTOn65+6aATttBa.. DATA
DWELLING TO THE PUBLIC SEWER
NEC!MOUSE SEWER
SI6NF( Tt IIS.._........"?..DAY
® - CONNECT ADDITIONAL
OWNER Orn / r BUILDING OR YORK
OWNEP.l- :o£qY_ .r_/.,;}iL(Ld1si��l._..(..S.LLC.� :.«-•r
REPTIC TANK.SEEP.PIT(8)
ARD/OR OT•Atl7FIEL0
p i HEREDY A_KRO%VLEDGE THAT I; VE READ THIS AP - CESSPOOL ORYWXLL
'CATR'LL
ION AND STATE THAT THE ABOVOIS CORRECT AND AGRSB
p u -WIYH.ALL”C.rISTY-^^D1f:aKCE3.A;Ml5T.ATE1 A!M. °LTC&Re.A!;I.9-01EXOR.
REGULATING PLUMBING AND SFV.f1". = SEWAGE CISPOBAL SYSTEM
jb .
I HEPV CERTIFY THAT I A212 PRv1'ERLY REGISTfOELS DISCONNECT
AN: �R LICEBBED A8 REQUIRED BY LOS ANGELES COUCIE7 ABAN
A OR THAT I Aill THE LEGAL OC74 DON HOUSE SEWER
STATE OF CALIFCRI(I
}� FR o: THE ABOVE DESCRIBED RESIDENTIAL PP-OPERTY., BAG LL 8 ANK
�® SEEP.PTT(S)o CE" DOLS
SIGNATURE
OF PEft"ITTEEilk
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