HomeMy Public PortalAbout9020 LONGDEN AVE_Sewer__ 76A842D 4 APPLICATION
CE6089-e6 APi LICATION FO P RM
IT ,
COUNTY OF LOS ANGELES S WER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING �+
BUII.DING AND SAFETY DMSION ADDRESS
OHN A. LAMBIE, Co%TtF Ea eer v
C A1T D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FBUILDINGS
OR APPLICANT TO FILL IN CROSS ST.
OF
LOT NO. p OWNER
TRACT MAIL
d ADDRESS
NO OF 3 X/' C> NOW ON LOTS CITY TEL NO.
DISTRICT NO GROUP MAP ZPRWESSED
- = / BK PG I '
CONTRACTOR��
I
ADDRESS, -• CONNECTION DATA
CITY � /`/ L,N0. l �� STATION J DEPTH �. '
8STATE MANHOLE REFERENCE
REGISTRATION NO. COUNTY 13
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 lDE1
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH .L. /
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0. - -
PRIVATE DISPOSAL SYSTEM @ $1.00 CO IMP. NO. / JOB NO.
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO. ROAD PERMIT NO.
l WORK TO HOUSE SEWER @ $1 00 -�P>
SEWER OR PAIR O ABANDON SYSTM HOUSE @ $1 00 STA ENCROACHMENT
PERM
INDUSTRIAL _
WASTE APPROVA
-CHARGES
OWNERS PERMIT $ 1 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 1 J REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS D Y�OF ' 1 NEW HOUSE SEWER 'f D
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS h / r '� SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT-,I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE AL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE ( SEEP.PIT(S CESSPOOLS
OF PERMITTE 2
Or VALIDATION ROBERT A. WOOD
� g,p, / Cpgq SUPERVISING MECHANICAL ENGINEER
DEPARTMENT OF COUNTY ENGLNEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENDINEER ` I BUILDING
ADDRESS
FOR APPLICANT TO 51 IN LOCALITY
BUILDINGNEAREST
ADDRESS q 6 1 P CROSS ST. ,
LOCALITY DISTRICT NO SERIAL NO. P,,((ERMIT NO. c
NEAREST �j� A /�16 S
�
CROSS ST.
RECEIVED By Ready for Inspection DATEISSUED
OWNER
MAIL USE ZONE I OCCUPANCY BK PG MAP
ADDRESS //1CCJPA N
CITY TEL.N . A
CONTRACTOR c CO.IMP.NO.
ADDRESS (� (� JOB.NO.
CITY TEL-NO- �® l TRUNK PERMIT NO.
STATE
REGISTRATION ( ' 8 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO. _
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS. CHARGES
NOW ON LOT
USE
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO• o DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 a- O MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS ; I I 00
Y. CURB P.L. M.L.TO P.L.
PERMIT
AUTHORIZATION I ---� an
I 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._-_._-._.._DAY OF.__._...._....,.._.__-___..14_-_._ NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT.....................................
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.............._......_....-.-........--_.•----...___.._-._.._..-..._.._....---.-. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RE DEN IAL P OPERTY. BACKFILL SEPTIC TANKS
SIGNATUREA SEEP.PIT(S)� CESSPOOLS
.. .-.
OF PERMITTEE.
76A642A 663 7/53