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HomeMy Public PortalAbout9112-9114 LONGDEN AVE_Sewer__ D S&E-683 11-55 APPLICATION FOR PERMIT 8 8 E.8 DIVISION OF BUILDING AND SAFETY SEWED—SEWAGE DISPOSAL Department of County Engineer -County of Los Angeles BUILDING ©�/� r� ff /.. t^� _/ � ,�,` JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 7 ! 1& r �( V ® CASSATT D GRIFFIN, SUP T DP BUILDING - LOCALITY V�l L E C FOR APPLICANT TO FILL IN CROSS ST.LEGAL DESCRIPTION LOT NO -02OWNER MAIL BLOCK TRACT ADDRESS NO. OF EFLDGS - CITYTEL NO SIZE OF LOT 10MNOW ON LOT USE OF DISTRICT NO. GROUP MAP BUILDINGS BK PG CONTRACTOR Z CONNECTION DATA ADDRESS l - T STATION �'�" _�— DEPTH o CITY TEL. NO. UPP MANHOLE REFERENCE ❑ STATE REGISTRATION NO ❑ COUNTY �- d s NO. DESCRIPTION OF WORK FEE ' •��r1-FFLL 60 77 O/ r �� HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROMa _ PUBLIC SEWER @ $3 50 Y. CURB P L M L TOP L SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 P OVERFLOW SEEPAGE PIT,DRAINFIELD C. N0. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO. IMP. NO.� 106 NO , HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR / STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 v V PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL ' SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL ' CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 � REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE �' ,sd I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEW R r NEW HOUSESEWER SIGNED THIS r DAY OF 19_ CONNECT ADDITIONAL OWNER ORG / � '- BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESSe,41 ' - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ T S APPLIC ION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE-ISO RRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS ( SEWAGE DISPOSAL SYSTEM 1 HEREBY ' ERTIFY 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 I AM T LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTI L PROPE BACKFILL SEPTIC TANKS❑ /� y _ SIGNATURE _ Al SEEP PIT(S) C3 CESSPOOLS 37 -&--41 OF PERMITTEE - I JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIROBERT A WOOD, CHIEF PLBG. INSPECTOR CK. 01 0 CAH - LA-Co 4540- MAR 28 4 - 5.50 in