HomeMy Public PortalAbout8808 LONGDEN AVE_Sewer__ D
8&E.663 3.55 APPLICATION- FOR PERMIT
8& -6
DIVISION .OF BUILDING AND SAFETY SEWER-SEWAGE D9SPO$AL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST..
LEGAL
DESCRIPTION LOT NO. / I OWNER -
BLOCK TRACY —g(f MAIL
ADDRESS
N0. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY EL. NO.
USE OF ��'S I,(,.�,F,UC� zi
BUILDINGS DISTRICT NO. I GROUP MAP
BK PPG
CONTRACTOR /� /
i > �L� fff✓✓✓
ADDRESS / CONNECTION DATA
CITY TEL. NO. STATION �.� DEPTH '
❑ STATE MANHOLE REFERENCE ` UPPER
REGISTRATION NO. ❑ COUNTY ¢
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB 'P.L. M.L. TO P.L.
PUBLIC SEWER '@ $
HOUSE SEWER CONNECTING TO
P RIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. 1MP. N0. / (/ JOB NO.
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT.
_ AND/OR DISPOSAL SYSTEM 1.00 PERMIT.NO.
SEPTIC TANK, SEEPAGE PIT OR --
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
o0
OWNER'S
PERMIT CONNECTION CHARGE FEE,
�
AUTHORIZATION TOTAL. FEE REIMBURSEMENT FEE
IHAVE CON-
TRACTORTTOS DATE CONNECT THE ABODVEWITH THE DESCRIBEDHEREIN EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER r
SIGNED THIS ` DAY OF Ac Fcs.7 1g / NEW HOUSE SEWER
fr-7-s i 9li. _
CONNECT ADDITIONAL r
OWNERS OWNER AGENT ' r�'Gd.'rte BUILDING OR WORK
ADDRESS I / SEPTIC TANK,SEEP, PIT(S)
_ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDG THAT HAVE R AD THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS ORRECT AND AGREE TO COMPLY
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
LICENSE S REQUIRED BY LOS ANGELES COUNTY AND ST E OF DISCONNECT PLUG AND -
CALIFORAI OR THAT I THE GAL OW /ER OF T ABO BA ON HOUSE SEWER
DESCRIBED ID�IAL P _
BA ILL
CESSPOOLS
SIGNAT E
OF PERMITTEEr7 _
WILLIAM J.FOX.COUNTY ENG ER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
\
DEPARTAlENT OF COUNTY ENGINEERSEWED—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF L09 ANGELES ) BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS `-�`,�jj//�� bv, \
FOR APPLICANT TO FILL IN -` LOCALITY
BUILDING60,E p �+ NEAREST \. C/ C�
' ADDRESS U�JO(_i E Longden Lo �en Ave a - CROSS ST.
LOCALITY Temple City DISTRICT NO. SERIAL NO. QPERMIT-NO. C
NEAREST _ A 17 � 2-5— J
CROSS ST. {{
RE ED BY Ready for Inspection DATE ISSUED
OWNER Creative Builders ��;
MAIL
ADDRESS USE ZONE OCCUPANCY MAP PG
J
CITY TEL.N0. �r. A BK
CONTRACTOR '
CO.IMP.N0.
ADDRESS H. P. I'PEDR 1
270() yclilderhoof DF. JOB.N0.
CITY Covina,nW99. FL 2374A
TRUNK PERMIT N0.
STATE
REGISTRATION NO. / ® COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. J STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 5 �Q INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_ PUBLICSEWER Q $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO r
PRIVATE DISPOSAL SYSTEM 1.00 D d
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 .
ALTER OR REPAIR EXISTING F.OI DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
PITS AND/OR DRAINFGE DIT OR 2,00 2 '00f
STATION _ DEPTH
q CESSPOOL—DRYWEL'L
Y SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 00 Y CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I QO
1 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...l5_.........DAY OF. January NEW HOUSE SEWER r� '��
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.-_......_.__._._._. _ - BUILDING OR WORK
_...-•---.........-...........••-•--
ADDRESS---------------_----------__.__.-. SEPTIC TANK,SEEP.PIT(S)
- •-------.•..--.._....-._...----...-.--.--•-------._ ! AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOODRYWELL E] =vw!CATION AND STATE THAT THE ABOVE 13 CORRECT AND AGREE .' !r
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY o ABANDON HOUSE-SEWER
AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESC 1 RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS Ej
OF PERMIT - =
/53