The URL can be used to link to this page

Home My Public Portal About9121 LONGDEN AVE_Sewer__ 76A 6420 -CE808 -10-71 APPD_I CA OiV FOR P HT COUNTY OF LOS ANGELES EWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING n ADDRESS /J �^ f LOCALITY i- NEAREST FOR APPLICANT TO FILL IN CROSS 5T f LEGAL J ' DESCRIPTION LOT NO OWNER ''✓ �� G MAIL BLOCK TRACT l ADDRESS NO OF BLDG$ If SIZE OF LOT NOW ON LOT CITY TEL NO 3 USE OF DISTRICT NO GROUP MAP (Zak BUILDINGS BK P CONTRACTOR /fJ� ADDRESS CONNECTION DATA CITY TEL NO STATION DEPTH STATE LIC MANHOLE REFERENCE UPPER LICENSE NO CLASS ..Q*Vo&' NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB L M L TO P IL PUBLIC SEWER (9 $7 00 SEPTIC SANK SEEPAGE PIT OR P PITS AND/OR DRAINFIELD @ $1000 CO IMP NO 0 �9 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO i- PRIVATE DISPOSAL SYSTEM $3 00 O r CONNECT ADDITIONAL ^ AFFIDAVIT WAIVE■ '!AS[Ml.T RECORD INSTR NO DATE V WORK TO HOUSE SEWER @ $300 l/ OVERFLOW SEEPAGE PIT DRAINFIELD OC EXTN CESSPOOL DRYWELL @ $5 00 Q HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE F- SEWER OR DISPOSAL SYSTEM $3 00 STATE ENCROACHMENT W MANHOLE $7 00 PERMIT NO d INDUSTRIAL WASTE APPROVAL OWNERS PERMIT 3 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE d IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER FDNG PPROVALS DATE INSPECTOR'S ATURE SIGNED THIS DAY-OF 19_ OWNER OR OUSE SEWER 1 OWNERS AGENTS ECT ADDITIONAL RVl ING OR WORK ADDRESS C TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS OOL ❑ DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND�OR ,REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OFGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TONNECT PLUG ANO RESIDE IN THE A E DESCRIBE RESIDENTIAL PROPERTY ON HOUSE SEWER SIGNATURE , ❑ILL SEPTIC TANKSOF PERMrrTEE TPIT(S) E POOLS ❑ VA •^ ON CK M.0 CASH 8 3r1Y b 1 8 6.00W-18 - ��.(q c r �g�..q(, ods 76A642D APPLICATION FOR PERMI ■ 7 13&E•663 12.54 i 1 DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL. Department of County Engineer Cbunty of LOB Angeles L NG q M.J. FOX. COUNTY ENGINEER SS Gf/ CA83ATT D. GRIFFIN.SUPT OF BUILDING ITY -r�%A4 - FOR APPLICANT TO FILL IN NEAREST CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER BLOCK A, qj'TRA MAIL 47 ADDRESS NO OF BLDGS. - SIZE OF LOT NOW ON LOT CITY TEL NO. USE OF to0 BUILDINGS DIT NO. I GR I MAP •�l BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY ,a AA TEL. NO.,�& STATION s�' DEPTH A ❑ STATE Q M ERENCE REGISTRATION NO. (J ❑ COUNTY UPPER I tom` - TYPE OF CONNECT LENGTH FROM Q NO. DESCRIPTION OF WORK FEE Y CURB P L M L TOP L HOUSE SEWER CONNECTING TO PUBLIC SEWER Q $ 3 50 13 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG. OR �0-0 a CO. IMP. NO. /S-D/ 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 AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK, SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 ,. CHARGES PERMIT CONNECTION CHARGE FEE OWNER'S S 1 00 AUTHORIZATION TOTAL FEE I 4VI:) REIMBURSEMENT FEE IHAVE CON- TRACTOR TO CONNECT DATE O THE ABOVE CTED WDESCR DESITH THE CRIBED EXISTING EREIN A DWELLING APPROVALS DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER SIGNED THIS-DAY OF y199_ NEW HOUSE SEWER OWNER OR ��II gy Q � CONNECT ADDITIONAL OWNERS A N / / (� Q BUILDING OR WORK ADDRESS %")-nIl eJ)rf�Q � SEPTIC TANK, SEEP, PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION CESSPOOL[__1 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 I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/QR 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 RESIDENTIAL PROPERTY. BACKFILL TANKS SSPOO❑LSDg, SIGNATURE OF PERMITTEE WILLIAM J. FOX.COUNTY ENGINEER VALIDATION .ACO 6 8 2 0 AUG 17 -4 5.5 0 BY BY - DEPUTY DEPUTY BY BY ® DEPUTY �DEP�