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HomeMy Public PortalAbout8854 LONGDEN AVE_Sewer__ CEBOB 3-62 A I�I�II ICA 4O®®R PERM OT 7sn642D i�ll�lf L� PU II PERM OT OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADOREss Q E COLEMAN W. JENKINS, SUPT. OF BUILDING If LOCALITY NEAREST J FOR APPLICANc�T TO FILL IN CRosS ST. (9 f CIALEAL Q N DESCRIPTION LOT NO. 4ya Ly® ® OWNER Wj 0t-1 MAIL c }� BLOCK TRACT � ® ADDRESS S a au G NO. OF BLOGS. �/'p. SIZE OF LOT NOW ON LOT CITY S �V•• TEL. NO. ^r®/1< li USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG �I CONTRACTOR '' Y J- ADDRESS �n �LN CONNECTION DATA A CITY yZ ©� 6 �3 ,V� STDEPTHSTATE LICENSE NO,: V LIC 2AiSNH LEE JEFERENCE E� UPP R,�- V C,LA'SS 'rL s inC _Z 9 OWER NO. .DESCRIPTION OF WORK FEE I TYPE OF CONNECTION LENGTH FROM P. M.L.TO P.L. HOUSE SEWER CONNECTING TO r ® Y.. CURB d 5 PUBLIC SEWER @ $5.00 SEPTIC TANK.SEEPAGE PIT OR Q ' O NO. O CO.IMP. . J OB NO. PITS AND/OR DRAINFIELD @ $10.00 NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $3.00 TRUNK PERMIT NO. ` ROAD PERMIT NO. --- , 0 �e O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMEnT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT.DRAINFIELD d EXTN..CESSPOOL.DRYWELL.MA NH OLE @ $5.00 / ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING y SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT z PERMIT NO. _ya+ INDUSTRIAL WASTE APPROVAL OWNERS PERMIT a z 00 CHARGES AUTHORIZATION TOTAL FEE 1 70 CONNECTION C}LA RGE FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. RE!,N46U RSEMENT FEE TRACTOR TO CONNECT THE ABOVE,DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS ALS DATE INSPECTOR'S SI NATURE SIGNED THIS DAY OF 19_ A.� t p � OWNER O� NEW HOUSE SEWER OWNERS A _L CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 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 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESC ED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER ATUREIT E SIGNBACKFILL SEPTIC TANKS El OF PERMI✓�'r �- SEEP.PIT(S) [ICESSPOOLS ❑ L j UIV ( v VALIDATION JACK R. ALLEN SUPERVISING MECHANICAL- ENGINEER CK. M.O. CASH Lko s' JUL 18 1 a o 7.Q 0 N v u