The URL can be used to link to this page

Home My Public Portal About8862 LONGDEN AVE_Sewer__ r o 76A642D CE 808 J(REV.6/78) ,/79 ApPUCA MN FOR PER OT �S SEWER - SEWAGE DISPOSAL COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN DISTRICTNV. G MAP PR CESSW BY / BK! PG BUILDING �. '1O V Al/ S ADDRESS V 'y CONNECTION DATA LOCALITY` NEAREST STATION DEPTH CROSS ST. UPPER pp MANHOLE REFERENCE LOWER OWNER _ C... TYPE OF CONNECTION LENGTH FROM MAIL Y. CURB P.L. M.L.TO P.L. ADDRESS fp-nP.C.NO. CO.IMP.NO. JOB NO. CITY EL.NO LEGAL TRUNK PERMIT NO. ROAD PERMIT NO. DESCRIPTION LOT NO. AFFIDAVIT I WAIVER I EASEMENT RECORD.INSTR.NO. DATE BLOCK TRACT NO.OF BLDGS. SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING USE OF BUILDINGS STATE ENCROACHMENT PERMIT NO. INDUSTRIAL CONTRACTOR WASTE APPROVAL ADDRESS CHARGES CITY u TEL.NO. CONNECTION CHARGE FEE IL STATE LIC. REIMBURSEMENT FEE LICENSE NO. CLASS NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE HOUSE SEWER CONNECTING TO - PUBLIC SEWER SEPTIC TANK,SEEPAGE PIT.OR NEW HOUSE SEWER PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM Jm Ila / CONNECT ADDITIONAL BLDG.OR SEPTIC TANK,SEEP.PIT(S) WORKTO HOUSE SEWER AND/OR DRAINFIELD OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL ❑ DRYWELL❑ EXTN.•CESSPOOL.DRYWELL.MANHOLE ALTER,REPAIR OR ABANDON HOUSE ALTER,REPAIR,SEWER OR SEWER ORD ISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS❑ OWNER'S Permit $ SEEP.PIT(S)❑ CESSPOOLS❑ AUTHORIZATION IFTOTAL FEE VALIDATION I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19 OWNER A �� ., �;8 4 1,•8 A OWNERS AGENT , ADDRESS #IO OO:O 1',.0 1HEREBY ACKNOWLEDGE THAT'I HAVE READ THIS APPLICATION 21� O 1 /,. O O AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 4: WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLU M BING AND SEWERS. O I. 1 4:V,V U I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REOU IRED BY LOS ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO 9 RE- I •Z 1 I�(� SIDE IN.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. J SIGNATURE OF PERMITTEE 6A64 10-63 APPLICATION PP ICA TION ICOR PERMIT 76A642D /"lrrll� /"0 1 IV f PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT.OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 4OWMNER JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of Building FOR APPLICANT TO FILL IN LEGALDESCRIPTION LOT NO. h MAIL BLOCKTRACT V ADDRESS NO.SIZE OF LOT //j4,l � I NOWOON LOTS CITY T�• TEL, NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP C E5SED BY n S CONTRACTOR � ` � � �/�K �P� -L' ,.�A ADDRESS" 7 ` S .- ! CON, ECT4ION DATA STATION DEPTH CITY TEL. NO. ❑ STATE UPPER MANHOLE REFEREN REGISTRATION NO. ❑ COUNTY .LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. .L.TO P.L. a 'PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT JOB OR P.C.NO. O NO. CO. IMP. NO. PITS AND OR DRAINFIELD @ $10.00 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. (� PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT w tvE Ens EMENT RECORD.INSTR.NO. DATE 1'- WORK TO HOUSE SEWER @ $3.00 --�I V OVERFLOW SEEPAGE PIT,DRAINFIELD r -� a E XTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 _ EA R, NHOUSE HW ORS WIDE I G h Z SEWER OR-B15P6B�A�.�5-FSM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERIs PERMIT 2 00 CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARG EE 'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBT F URSEM EE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. A45PROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ - OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL � -,I'.�" BUILDING OR WORK s ADDRESS SEPTIC TANK,SEEP,1IT(5) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL 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 n ` ,`� �--+ CALIFORNIA ORTHAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRI D RESI.2L PROP.ERTY. ABANDON HOUSE SEWER SIGNATURE ' / �} BACKFILL SEPTIC TANKS ❑ OF PERMITTEE.! ! /"'� [ti�� ❑ .. . SEEP.PIT IS ❑ CESSPOOLS VALIDATIO ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER wA'Co 36 3 8 JUL 1 4 1 U A 8.00- tee'�Z��`"�`''``6� � �• ,� M—`. r .'�S&E•663 12.54 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DOSPOSAL Department of County Engineer County of Los Angeles BUILDING � 2 V WM. J. FOX, COUNTY ENGINEER . CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY ' FOR APPLICANT TO FILL IN NEAREST T t p� CROSS ST. LEGAL DE C .� RIPTION LOT NOFOP/i4 j'7jJ s, LOQ JJ r OWNER ; BLOCK TRACT4"-?0 1 MAIL' l / G3 �0 � ADDRESS rTj?!s (/ ��p ✓ NO. OF BLDGS. 1 SIZE OF LOT-fi9 A � NOW ON LOT 'Y^ CITY TEL. 0. �:j USE OF BUILDINGS DISTRICT NO. GROUP MAP CONTRACTOR ✓ I z I BK PG .G� � ,>-I'I gam . ADDRESS Q , CONNECTION DATA CITY L. NO. p _ STATION p ya 5L.0 2 DEPTH t;S STATE ,/rte 0 G, �,�/M�A NHOLE REFERENCE REGISTRATION,NO. /. � ❑ COUNTY— IAl.5'J�' �/ G'.�V UPPER L9dm` R'- _ . TYPEOSNN CTION LENGTH FROM A0 NO. DESCRIPTION OF WORK FEE Y. uRe P.L. M.L.TO P.L. HOUSE SEWER CONNECTING TO. PUBLIC SEWER q $ 3.50 -HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 J CONNECT ADDITIONAL BLDG. OR CO. IMP. NO.' / ✓� 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_ ENCROA `TENT 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 <c pERMT CONNECTION CHARGE OWNER'S S 00 AUTHORIZATION TOTAL FEE REIMBURSEI HAVE M NMED CON TRAC ORT TO CONNECTHIS DATE THEA A13ONTRCTEDVEVfDESCR BED EXITH THE ESNNGA DWELLING APPROVALS DATE INSPECTOR'S IVNATURE TO THE PUBLIC SEWER SIGNED THIS Za DAY OF 9 - NEW HOUSE SEWER OWNER- OR'- CONNECT ADDITIONAL - OWNERS AGENT '� BUILDING OR WORK .. � - _ • SEPTIC TANK, SEEP, PIT(S) ADDRESS AND/OR DRAIN.FI£LD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[IAND STATE—THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY' CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED DISCONNECT PLUG AN LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSED AND CALIFORNIA OR THAT.. I AM THE LEGAL OW ER OF THE ABOVE DESCRIBED ESIDEN IAO PROPE Y. /� BACKFILL SEPTIC TANKS❑ .!{/2//� SEEP:PITS) ❑. CESSPOOLsp T �G�NATURE OF PERMITTEE - WILLIAM J. FOX, COUNTY ENG606 VALIDATION BY BY _ DEPUTY - DEPUTY •� ",BY BY J ,`70 DEPUTY DEPUTY