HomeMy Public PortalAbout9087 LONGDEN AVE_Sewer__ 76A642D ® �BocO�B @ _ �I ON C ®■ ■ ■ E MIT
S&E-663:3-53 PA 6 Ye A
DIVISION OF BUILDING AND SAFETY 'SEWER--SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITYNEAREST
FOR APPLICANT TO FILL IN CROSS ST. I
LEGAL ,
DESCRIPTION LOT N0. OWNER /� y A16-6
//
BLOCK 1 TRACT MAIL
1 /!J ADDRESS ' To L/ te a �►a A 6-6
f NO. OF BLDGS �+
SIZE OF LOT �/ NOW ON LOST@ CITY ` TEL. NO. —
BUILDINGS ® 45
ff C DISTRICT•NO. GROUP MAP
BK �CONTRACTOR
ADDRESS "'3 ,ri (� CONNECTION DATA
CITY TEL. N.O. %E? 'STATION `¢ DEPTH
` ❑ STATE !MANHOLE REFERENCE
REGISTRATION NO �'; ❑ COUNTY 1 '�j l OWER
NO. DESCRIPTION OF WORK FEE t TYPE OF CONNECT LENGTH FROM
HOUSE SEWER CONNECTING TO L>J Y CURB P L M L TO P L
PUBLIC SEWER $ 3 50 id
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 ,}
CONNECT ADDITIONAL BLDG. OR � /� P C NO.
_ WORK TO HOUSE SEWER 1 00 CO IMP NO Id 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 00INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00• CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S $ 1 00
AUTHORIZATION TOTAL FEE 50 REIMBURSEMENT FEE
TRACTORHAVE OS CONNECTO NTRTHEAABOVEDESCRBED EXSTINGCTED WITH THE HEREIN AMED CON-
DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER_- ,! -
t Vr NEW HOUSE SEWER
SIGNED THIS THIS DAY OF _
OWNER OR �,��`/� CONNECT ADDITIONAL
OWNERS AGENT ___ �" 1 '}°lm' BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS 'AND/OR DRAINFIELD
IOACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF -DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER,
DESCRIBED RESIDENTI L ROPERTY. / BACKFILL SEPTIC TANKS[I
/ SEEP. PIT(S) ❑ CESSPOOLS _
SIGNATURE
OF PERMITTEE / - - - - -
Z
WILLIAM J.FOX.COUNTY ENGINEER VAMDATION R..A.WOOD, CHIEF PLBG. INSPECTOR
L