HomeMy Public PortalAbout9120-9122 LONGDEN AVE_Sewer__ 6&E-6U
s - APPLICATION FOR PERMIT 1
.BeDIVISION OF BUILDING AND SAFETY SEWED—SEWAGE DISPOSAL -
Deportment of County Engineer
County of Los Angeles BUILDING p -
JOHN A LAMBIE, COUNTY ENGINEER
ADDRESS A
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS s.
LEGAL
DESCRIPTION LOT NOOWNER
MAIL (�
BLOCK TRACT , ",rl� ADDRESS 7)If 1
®
NO OF OF BLDGS i
SIZE OF LOT NOW ON LOT CITY I NO �, o
USE OF
BUILDINGS DISTRICT GROUP MAP '
BK PG
CONTRACTOR y
16
�.-- CONNECTION DATA
ADDRESS
STATIONQ DEPTH
CITY TEL. N0. h/(�B MANHOLE EFERENCE PPER
57'
❑ STATE r
REGISTRATION NO. el 4' 7 ❑ COUNTY -
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONy,ECTIO LENGTH FROM of
PUBLIC SEWER @ $3 50
R§ P M.L.TO P L. p�
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD P C NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP, NO JOB NO
t
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRI
SEWER OR DISPOSAL SYSTEM @ $100 WASTE APP AL
�G AR
GES
CONNECTION CH FEE
OWNER'S PERMIT S 11 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE ,
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER S
SIGNED THI DAY OF 19 CONNECT ADDITIONAL
OWNER 'OR - t� BUILDING OR WORK
OWNERS,AGENT A M >rA
T
/ p SEPTIC TANK,SEEP,PIS)
ADDRESS L 11 Y AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT II HAVE REA THIS APPLICATION CESSPOOL[-] DRYWELL❑
AND STATE THAT THE ABOVE IS l RRECT AND AGREE!?0 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 I AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTIP OPERTY BACKFILL SEPTIC TANKS❑ / f ��
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS J
OF PERMITTEE T ,
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
-,. CK. 8 0. .CASH
i-
0 4 7 6 2c-- FEB 4 4 - 5.5 0 a
76A 642D - CE808 - 9/73 APPLOCATT� ®R P 0T
COUNTY OF LOS ANGELES R—SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ffARDF.
(,(„�- (�•W{y G'_
j
�"�' `� \LiC
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPA`T(I1ON OWNER
IL
s,/ �x��l.. ��y�VV�/T�I�//✓��
`�J Q V �V MA
ADDRESS
BLOCK TRACT ,Q f
NO OF BLT X-_ C L NO t'L4 p
SIZE OF LOT NOW ON LOOT CIT
USE OF
BUILDINGS DISTRICT NO GROUP BK AP PS CESSED BY
GONTRACTOR D Q V
ADDRESS CONNECTION DATA
STATION DEPTH
CITY TEL NO
STATE LIC MANHOLE REFERENCE / UPPER
LICENSE NO. OLA66
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L ML TOP L
PUBLIC SEWER 0 $7 00
PC NO
SEPTIC TANK SEEPAGE PIT OR
CO IMP NO JOB NO
PITS AND/OR DRAINFIELD $1000
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM Q $300
CONNECT ADDITIONAL BIt�Aw�BfiF AFFIDAVIT WAIYEE EASEMENT RECORD INSTR NO DATE r
WORK TO HOUSE SEWER ® $300 -3
OVERFLOW SEEPAGE PITDRAINFI
EXTN CESSPOOL DRYWELLP—WA $500 U
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING O
SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT
MANHOLE $7 00 PERMIT NO W
INDUSTRIAL N
WASTE APPROVAL cn
OWNER'S PEFIM f $ 00 CHARGES
AUTHORIZATION A00
TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS
BUILDING OR WORK
SEPTIC TANK SEEP PIT(8) -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AN GREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND ST E LA S REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ '
IS CE Y TH I AM PROPERL REGIST ED AND/OR ALTER,REPAIR SEWER OR
LICENSED AS EOUIR D BY LOS ANG C UNTY AN STATE OF SEWAGE DISPOSAL SYSTEM
CALIFCANIA R THAT AM HE LEGA OW OF AN INTEND TO DISCONNECT PLUG AND
RESIDE IN eHE ABOV DE RIBED RESID TI PROPERTY ABANDON HOUSE SEWER
e
SIGNATURE BACKFILL SEPTIC TAN 5 ❑
OF PERMTTTE _ * SEEP PIT(S) ,0' CES POOLS ❑
VALMATION 11 CK./�, M.0. CASH
2 9 612AUG 26'1 0 6.0 0 e�is
1 r