HomeMy Public PortalAbout8802 LONGDEN AVE_Sewer__ . 2 46550 INSERTS
CEO 6.60 AP � CAT ® V, FOR PERMOT-
76A6420 _
COUNTY OF LOS ANGELES SEWER-SEWAGE pp pp
DEPARTMENT OF COUNTY ENGINEER
'BUILDING
BUILDING AND SAFETY DIVISION
ADDRESS.•- ..
JOHN A. LAMBIE, County Engineer s
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO gILL IN ceoss sr.
42
LEGAL /�. ,� OWNER. '
DESCRIPTION LOT NO.. es
BLOCK - TRACT- a MAIL
j � 5ADDRESS
�/ C. NO.OF BLDGS.
SIZE OF LOT O/� L/ N04Y ON LOT 'CITY " TEL. NO.
° USE OF
BUILDINGS DISTRICT NO. GROUP - MAP PROCICg\ D BY '
A �7—I. /j 0G. 1 �-�'L"Ef -1
CONTRACTORri :0
ADDRESSCdNIIECTION DATA
CITY TEL.NO. STATION s DEPTH
COUNTY d, MANHOLE REFERENCE %UPPER'
REGISTRATIO N0. _ -
NO.. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 - TYPE OF htNE"TION LENGTH FROM
PITS AND/OR EPTIC DRAINFIELDSEEPAGE PIT OR @ $3,00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00 .
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. N0. 3 JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. `� O
WORK TO HOUSE SEWER @ $1.00
_ SEWER REPAIR
SAABANDON L SYSTEM HOUSE @ $1.00
1 00 STATE ENCROACHMENT -'
a PERMIT N0. p
INDUSTRIAL F
U
WASTE APPROVAL W
a - CHARGES
OWNER'S PERMIT $ 2 00 ;' CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE G REIMBURSEMENT FEE
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-.
TRACTOR TO CONNECT THE ABOVE DES4RIBED EXISTING DWELLING - APPROVALS DATE INSgECTOR-S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THI 19, DAY OF 19—UNEW HOUSE SEWER
+e. OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT "BUILDING OR WORK
t ADDRESS - SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD '
1 HEREBY ACKNOWLEDGE THAT I HAV EAD THIS'APPLICATION
AND STATE THAT THE ABOVE IS CORREC AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWEROR -- -
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM '
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED Y LOS GELES. COUNTY AND STATE OF ABANDON HOUSE SEWER
-
CALIFORNIA OR THA I M TH LE OWNER OF THE ABOVE -
DESCRIBED RESIDEN • P OPER a BACKFILL SEPTIC TANKS ❑ / q h�f I
a SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITTE aj
-
,.u.
c
OF � ALIDATION ROBERT A. WOOD"
CK. M..0. CASH SUPERVISING MECHANICAL ENGINEER -