HomeMy Public PortalAbout9026 LONGDEN AVE_Sewer__ S&E-6G APPLICATION FOR PERMIT 1
8DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS s.
LEGALI / /` _?J }f .z1L1I1f�I�J
DESCRIPTION LOT NO OWNER /e-� ✓� f7
BLOCK TRACT MAIL
O ADDRESS
G�'/� N0.OF BLDGS /' CITY TEL. NO
SIZE OF LOT o V 1� NOW ON LOT-
USE OF DISTRICT N0. GROUP MAP
BUILDINGS J
S I I BK/ ,J�qP,,GII
CONTRACTOR
J �^ A �q� �+ 1 CONNECTION DATA
ADDRESS`7[�^Y�f�►• �G TD ��G�. e� _
CITY TEL. NO STATION f � DEPTH !
MANHOLE REFERENCE- UPPE
STATE LOWER
REGISTRATION NO ❑ COUNTY n !
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y. CURB PL ML TO PL.
'/ PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELDJ P. C. N0.
/5'0EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP. NO. / JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE
I HAVE AT THIS DATE-A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING A '
TO THE PUBLIC SEWER NEW HOUSE SEWER �',ZZ 5-
SIGNED THIS DAY OF 19�� CONNECT ADDITIONAL ✓f
OWNER OR r BUILDING OR WORK
OWNERS AGENT ^
SEPTIC TANK,SEEP,PITS)
ADDRESS •{ �+ AND/OR DRAINFIELD - - -
1 HERE ACKNOWLEDGE THAT I HAIE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ - -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTPROPERTY BACKFILL SEPTIC TANKS
SIGNATURE, SEEP PIT(S) ❑ CESSPOOLS
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR
6K�') M 0. CASH
tgo0 5 8 7S JA%22 ,4 A, . e�JO