HomeMy Public PortalAbout9014-9016-9016 1/2 LONGDEN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, 5ua'T OF BUILDING ADDRESS _
FOR APPLICIT T ILL IN LOCALITY ;; ,. r
BUILDING . . ,L�[.. NEAREST
ADDRESS CROSS ST, t r
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
,RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE 20NE OCCUPANCY MAP
I
BK PG
CITY L N
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS'/
f� REQUIRED
/ NOT REQUIRED
CITY TEL.NO.
JOB.NO. CONNECTION CHARGE FEE
STATE
REGISTRATION NO. COUNTY CO.IMP. NO.
LEGAL RECEIPT NO. I DATE IBY
DESCRIPTION LOT N0.
BLOCK TRACT WAIVER FOR RECORDING
NO.OF BLDGS.
SIZE OF LOT N WON LOT RECEIPT N0. I DATE BY
USE OF �
BUILDINGS
NO. I DESCRIPTION UP-
HOUSE
WORK FE TRUNK PERMIT NO.
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLIC SEWER @ $ 3.50
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1-00 STATION DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL UPPER LOWER
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ I 00 -
AUTHORIZATION TOTAL FEE - �-
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CbNTRAGTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-----------------DAY OF....................................... 19..---... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONKAL
-............
OWNERS AGENT.---.--- ............... ...
............... ..------- BUILDING OR WOR--------
SEPTIC TANK,SEEP.PIT(S)
ADDRESS----------------------------------------------..............---------------------------- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL X DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELE COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR HAT A HE AL OWN-
ER OF THE ABO SC BE P ERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)[:] CESSPOOLS
SIGNATURE
OF PERMIT E..-.. v. ---------------------------------------
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9&E-6633.98 I ®®Lt q®TI®Na S
FOR- ■ E■ \M'T��/�Tw
DMSION OF BUILDING AND SAFETY SEWER®SEWA DIS S
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS
WM.J. FOX, COUNTY ENGINEER ��
CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY r' �,�
NEAREST
FOR APPLICAN O L IN CROSS ST. 40 M A e
LEGAL
DESCRI T NO. OWNER P
BLOCK TRACT a MAIL � �. N n e
ADDRESS. Al
CX 6 �/NO OF BLD l„�/JLT
41
SIZE OF LOT .✓ NOW ON LOT CIT e ��'/ TEL. NO
USE'O
BUILDINGS DISTRICT NO. GROUP MAP
u / �j �j 1 B K PG
CONT A OR G E Y�jl�Y� ��� •i' J A���.J'
ADDRES — CONNECTION DATA
4(fTEL. N STATION �. ��}� DEPTH
f %
�j. ❑ STATE MANHOLE REFERENCE LOUR
REGISTRATION NO ❑ COUNTY
WER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO _ TYPE OF CONNECTI LENGTH FROM
Y. CURB rP L M L TO P L. dl
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 _
CONNECT ADDITIONAL BLDG. OR / P C NO
WORK TO HOUSE SEWER 1 00 CO. IMP N0. �6'�JQ JOB NO.
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 CHARGE
PERMIT CONNECTION CHARGE FEE
OWNER'S aD
AUTHORIZATION I TOTAL FEE ::j;i REIMBURSEMENT FEE
TRACTORHAVE TTOS CONNEC DATE ONT EAABOVECTED WDESCR BEITH THE D ERm ISTINGACON-
DWEL L IING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEW ,��`� A�
SIGNED THIS -DA 0 EW HOUSE SEWER �D'7.6 a S"f 6_tz6gP.�s'
OWNER ` CONNECT ADDITIONAL [�4��! �.Y4
OWNERS T BUILDING OR WORK
ADDRE v /J SEPTIC AND/OR TANK, SEEP,DRAINFIELDPIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL E) DRYWELL❑
AND 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA 0 HAT I AM THE LEGAA R OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED PR RTY. BACKFILL SEPTIC TANKS❑
G SEEP. PIT(S) ❑ CESSPOOLSLX D_2i4' S LZ.CKIy!/
SIGNATURE
OF PERMI �SIQEXTI
WILLIA J.FOX.COUNTY ENGINEE VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
lIC0 9 1 8 8- OCT 19 4 4.5 0 In