HomeMy Public PortalAbout9081 LONGDEN AVE_Sewer__ -76A6420 �iPY LIVA C IOOV , PERMIT
ERMIT 7
S e E-663 12.54 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
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Deportment of County Engineer
County of Los Angeles BUILDING `t
ADDRESS C) 0 Y
WM.J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY 41
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. G+�@
LEGALW-f-, 7 j*
DESCRIPTION LOT NO 75 Ir I OWNER
N
BLOCK TRACT j'Z ! MAIL DRESS '
NO OF BLDGS. 9
SIZE OF LOT NOW ON LOT G..._ CITY TEL NO
USE OF ►
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR
ADDRESS , CONNECTION DATA
CITY * TEL. NO. SON ON �� DEPTH 7...
STATE �+1 MANHOLE REFERENCE
REGISTRATI N COUNTY '^ OWER
TYPE OF CONNECTION 9 LENGTH FROM
No. DESCRIPTION OF W RK FEE Y CURB P L. M.L.TO P L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO. IMP NO. f/ / JOB. NO
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ----'ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
PND/OR DISPOSAL SYSTEM 1 00 PERMIT NO t
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
PERMIT CONNECTION CHARG _ --_.
OWNERS s 1 00 —
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT T E ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SE _
SIGNED THIS AY OF 19 NEW HOUSE SEWER
OWNER OR- CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE EAD THIS APPLIC ON CESSPOOL[3 DRYWELL[IAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM Y
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY 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 THE ABOVE
• DESCRIBE RESID IAL PR ERTY. BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑ CESSPOOLS
GNAT �f
OF-PERM TTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY ._.ado o e 7 6 US AUG���yyy��_8 4 4.5 0 �
DEPUTYc DEPUTY
BY BY
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