HomeMy Public PortalAbout9038 LONGDEN AVE_Sewer__ D
CE808 APPLICATION L,I CATION F®R PERMIT
1 .
lzeoe 11-577COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION MBABUI DDRESSG
JOHN A. LAIE, Count Engineer
CASSATP D. GRIFFIN, Supt o!]Building LOCALITY l /�
FOR APPLICANT TO FILL IN
NEAREST,
LEGAL
DESCRIPTION LOT N0. Z OWNER
BLOCK TRACT MAIL
Q ADDRESS - -
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT !/ CITY TEL.N0.
USE OF
BUILDINGS _ DISTRICT NO. I GROUP MAP
CONTRACTORO + ��� (/K ,P6
i 1
ADDRESS CONNECTION DATA
CITY! !J. TEL.N0. y STATION DEPTH
REGISTRATION NO. COUNTY MANHOLE REFERENCE UPPER
LOWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO + eq
PUBLIC SEWER @ $8.50
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $9,00 Y. CURB P.L. M L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT
PERMIT NO
_ INDUSTRIAL -
WASTE APPROVAL
CHARGES
OWNER'S PERNIIT $ 111 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE n REIMBURSEMENT FEE
1 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 � DA OF 1 NEW HOUSE SEWER
OWNER OR - T'1~ CONNECT ADDITIONAL - - - - , •'•
OWNERS AGEN - BUILDING OR WORK 155 �j�
- SEPTIC TANK,SEEP,PIT(S)
ADDRESS-- - - AND/OR DRAINFIELD •`
I HERE9'Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �-
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRY-WELL❑ -WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
-
1 HEREBY CERTIFY THAT I AM PROPERLY' REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT IMAM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER _ _ _ -
DESCRIBED RESIDENTIA P OPER
TY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE
VALIDATION ROBERT A. WOOD y
H.0 Cesx SUPERVISING MECHANICAL ENGINEER
2 2 2 8 .JM 28 •'1 0yA -3.00