Loading...
HomeMy Public PortalAbout9045 LONGDEN AVE_Sewer__ 76A642D APPLICATION FOR PERMIT 1 5&E-663 12.54 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL _ Department of County Engineer County of Los Angeles BUILDING +► WM.J. FOX, COUNTY ENGINEER ADDRESS gn< CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY SAWA i :k F R APPLICANT TO FILL INNEAREST CROSS ST. r DESCRIPTION. I LOT N0. „/1 OWNER Fap BLOCK'-("•• �;� TRACT MAIL ADDRESS �•SIZE.ICIF•�LOT ONOF j CITY �. NO. U$E dF, H t,BU]Lt G5 .i DISTRICT NO. GROUP MAP ONTR. BAS 'VCONTRACTOR '?' _ "ADDRESS =' � ' 'to �,�> CONNECTION DATA .CITY TEL. NO. .A STATION 1 DEPTH /��►� E3 STATE MANHOLE REFERENCE REGISTRATION NO. 13�,j/ a E3 COUNTY UPPER / OWER (-, TYPE OF CONNECTI LENGTH FROM NO. DESCRIPTION OF WORK FEE Y CURB P L M L. TO P L. HOUSE SEWER CONNECTING TO O PUBLIC SEWER © $ 3 50 HOUSE SEWER CONNECTING TO _ •PRIVATE DISPOSAL SYSTEM 100 ;CONNECT ADDITIONAL BLDG OR CO. IMP. NO. J JOB NO ;WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING _ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT N0, ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO i SEPTIC TANK, SEEPAGE PIT OR --PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES PERARIT CONNECTION CHARGE FEE OWNER'S $ I 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTORHAVE TTO CONNECTHIS DATE ONTRTHEA ACTED B VEW IESCRBED EXIISTINGTHE HEREIN A DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWE SIGNED THIS Y OF b°� NEW HOUSE SEWER OWNER 9R� f P / CONNECT ADDITIONAL • ER� BUILDING OR WORK OWN SEPTIC TANK, SEEP, PIT(S) ADDRESS - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE AD THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT ND AGREE 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 DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ e e SEEP. PIT(S) ❑ CESSPOOLS ,. SIGNATURE OF PERMITTEE 14 / WILLIAM J; FOX.COUNTY ENGINEER VALIDATION BY "AC0 87 3 3 6!Q SEP 2 6 " ,�a�`� 4.50 • DEPUTY ( / DEPUTY BY BY ® DEPUTY ` DEPUTY