HomeMy Public PortalAbout9127 LONGDEN AVE_Sewer__ _ - FOR
PERMIT
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S&E•883 3.53 APPLICATION
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Deportment of County Engineer MO
County of Loa Angeles BUILDING �J �,
WM.J. FOX. COUNTY ENGINEER ADDRESS /
CASSATT D. GRIFFIN,SUP'TOFBUILDING LOCALITY ;�'�C.0
FOR APPLICANT TO FILL IN NEAREST 7
CROSS ST. l/
LEGAL _ - r / :9
DESCRIPTION LOT NO. � OWNCR + y J /�..LJ`
BLOCK TRACT MAIL
ADDRESS 90 52
NO OF BLDGS. -
SIZE OF LOT NOW ON LOT CITY TEY�f`0.
USE OF /�
BUILDINGS ®'J A 1 1DISTRICT NO. GROUP MAP
/��/ BK /PG
CONT _ 0 ® �C�/6�S B V 7 /V 1D
AD `�1U all-leiCONNECTION DATA
NO'.%e-j/Cy>/ l STATIONDEPTH
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�
�A _ /�g�� Gl ❑ STATE MANHOLE REFERENCE r
REGISTRATION NO f `L/G / Q ❑ COUNTY vi� / V"ecy r LOWER
NO. DESCRIPTION OF WORK FEE
H- SEWER CONNECTING TO TYPE OF CONNECT( LENGTH FROM
Y CURB P L M L TOP L. c/
PUBLIC SEWER til $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG. OR �L' I/ P C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO ��,,JJ Q �( 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 00 INDUSTRIAL -
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
o0
OWNER'S
PERMIT CONNECTION CHARGE FEE
� t
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE -� f) ldf P,1 PIC,
1 HAVE THIS DATE CONTRACTED WITH THE H REIN NAMED CON- G JV I�/ AV IV /
TRACTOR TO CONN T HE ABOVE DESCRIBED EXISTING DWELLING i APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLICS 4A//%�
SIGNED THIS DAY OF NEW HOUSE SEWER e-z , -j%
CONNECT ADDITIONAL �a� !+
OWNER OR _ BUILDING OR WORK
OWNERS
SEPTIC SEP,
ADDRESS ' �B!� AND/RTDRAINFEELDPIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP (CATION CESSPOOL[I DRYWELL[IAND 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 ANGE COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT t AM THE OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED IDf,NN�tT -PRO ERT . BACKFILL SEPTIC TANKS❑
,_..� SEEP: PIT(S) ❑ CESSPOOLS -
SIGNATUR ¢,
OF PER T
WIL M J.FOX,COUNTY EN NEER VALIDATION R.A. WOOD. CHIEF FLOG. INSPECTOR
.9222-u OCT20 4 4.50 �'