HomeMy Public PortalAbout9128 LONGDEN AVE_Sewer__ @E-66311.55 APPLICATIONN FOR PERMIT QM.45 IT _
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DI POSA L .-
Department of County Engineer
County of LOS Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER J--LOCA
ADDRESS
® CASSATT D GRIFFIN, SUPT OF BUILDING - LITY J
FOR APPLICANT TO FILL IN NCaoss ST.
LEGAL 4
�SO O �( -
DESCRIPTI N . LOT NF; OWNER Y -
BLOCK TRACT MAIL
ADDRESS
. OF BLDGS. CITY
�-
leSIZE OF LOT NOTEL. NO.
ON LOT '
USE OF D STRICT NO. GROUP MAP
BUILDINGS-7 - / n BK /PG
CO5xaAx i
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CONNECTION DATA
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•C L. ' TION ��1 DEPTH ®-
�/ MANHOLE REFERENCE _ _ g'>
❑ STATE � / �'�� ( LOWER
REGISTRATIO 0. ® ❑ COUNTY
N olf DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTI LENGTH FROM-
PUBLIC SEWER @ $3.50 - Y. CURB P.L. _ M L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00 _
OVERFLOW SEEPAGE PIT,DRAINFIELD P C. NO, '
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO, IMP NO. JOB NO. -
HOUSE SEWER CONNECTING TO ,
PRIVATE DISPOSAL SYSTEM Q $100 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT,
WORK TO HOUSE SEWER Q $100 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q •$100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE - r
OWNER'S PERMIT $ 1 00 .
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE /T �[�—P4
I HAVE AT THIS DATE A NTRACT WITH T ER k NAMED CON- - APPROVALS DATE INSPECTO R'S SIGNATURE
TRACTOR TO CONN E ABOVE DE D EX TING DWELLING
TO THE PUBLIC SNEW HOUSE SEWER 2_ -s�� ��
SIGNED THIS DAY 01- -�`� -- 1 CONNECT ADDITIONAL r r
OWNER OR (� BUILDING OR WORK
OWNERS AGE / SEPTIC TANK,SEEP,PIT(S) ,
ADDRESS L— AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE REA HIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT -AAGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR AND
DISCONNECT PLUG
LICENSED AS REQUIRED BY LOS ANGELES -UUTjITY AND STATE OF ABANDON HO PLUGUSE D
CALIFORNIA' OR TWW I AM HE LEGAL W R OF THE ABOVE
ER
DESCRIBED RESIDE R T / BACKFILL SEPTIC TANKS❑ !J
SIGNATURE SEEP PITS) Ll CESSPOOL S 2
OF PE
JOHN AMBIE, COUNTY ENGI ER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
- CK d O CASH - •�
tet 5 & 2 fa6 4 4.�J 0