HomeMy Public PortalAbout9042 LONGDEN AVE_Sewer__ S 8 6.688 3.55 APPLICATION - FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer
County of LOS Angeles BUILDIADDRESG
WM.J. FOX, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY• \
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL 1 �/
DESCRIPTION LOT 140 ` � �� OWNER
G MAIL '
BLO K T (,ADDRESS
BLDG
S
SI LOT ON LOT CITY TEL. N
USE OF
BUILDINGS DISTRICT
NO. GROUP MAP
CONTR BK PG
D E i _ f / CONNECTION DATA
C `l TEL N .S "STATION / DEPTH
�t ❑ STATE MANHOLE REFERENCE O g. 3��
REG ISTR ION NO ❑ COUNTY Y LOWER
NO DESCRIPTION OF WORK FEE
TYPE OF CONNECT( LENGTH FROM
HOUSE SEWER CONNECTING TO I+Li Y CURB P L tt.L TO P L.
PUBLIC SEWER @ $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _ n
CONNECT ADDITIONAL BLDG. OR d/ PC
N0,
WORK TO HOUSE SEWER 1 00 CO. IMP NO l 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 CH S
$ o0
OWNER'S
PERMIT CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 'J( REIMBURSEMENT FEE L%
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN AMED CON-
TRACTOR TO CONN CT THE ABOVE D; gQED EXISTING DWELLING _ APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S
SIGNED THIS -DAY OF IL i�•�
NEW HOUSE SEWER (� y,�j �g
�' u %7t fF
1 F CONNECT ADDITIONAL
OWNERS A
OWNER OR ��� , BUILDING,OR WORK
GE
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREB ACKNOWLEDGE THAT 1 HAVE REA IS APPLICATION CESSPOOL❑ DRYWELL❑ -
AND STATE THAT THE ABOVE IS CORRECT AN GREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR _
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNT AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR T T 1 AM THE LEGAL OWOF THE ABOVE _ABANDON HOUSE SEWER
DESCRIBED RES[ AL���•••PROP Y. f BACKFILL SEPTIC TANKS 1-;
$EEP. PITS ❑ CESSPOOLS bd
SIGNATURE LLb `/ 4 `-'
OF PERU .'i
WILL
A J.FOX. COUNTY ENGINE VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
L _ _ ,.