HomeMy Public PortalAbout9133 LONGDEN AVE_Sewer__ :61304 565
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COUNTY OF LOS ANGELES SEWER SEWAGE
APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER DISPOSAL
BUILDING AND SAFETY DIVISION BL;iLDI
..........
ACORE 3�_l
COLEMA'\ V;, JLNUNS, Sup't. of Building.
LOC
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FOR APPLICANT TO FILL IN
LOT NO. OWNER
_DESCRIPTION
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'BLOCK TRACT ADDRESS
NO OF BL GS.
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SIZE-OF LOT NOW ON LOT CITY 'TEL, NO.
USE OF'
-BUILDINGS DISTRICT N GROUP MAP PROCESSED BY
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SIZE
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CONTRACTOR
A A D E._ 3'9 CONNECTION DATA
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DDRESS
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CIT-" TEL NO A
ICE
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N ' pp
LICE IT L ICENSE UPPER
L MANHPI�E R,�ftR �EE
A LOWER
DESCRIPTI N OF WORK FEE TYPE OF CONNECTION LENGTH FROM
NO.
HOUSE SEWER C C.NN E c 4 IN Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER
P.C.NO, IL
PITS AND/OR DRAINF!E;�D $10T OR .00 CO.IMP. NO. JOB NO. 0
1110J$E SEWER C0NNECTWG IOTRUNK FERMI u
PRIVAIE DISPOSAL SYSIEM $ 3..00 T NO. ROAD PERMIT NO.
-r-CONNECT ADO{--i a Pj _DG._QR A F F—ID Ail�r_WA_j" A
RTE-S—E—ME-N—T T RECORD.IN57R.NO. DATE
WORK TO HOUSE SF%ER $ 3.00
---kL ImI_Olj5�E_________
5EYER OR-,Ll',S-P"A-E SYSTEM 7 13 3 00 i LLj
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_�,ERT Li5W__5_FS-A lE�fT_0R_ATNFTE_L G____- HWY, OR ST_WIDENING 4.
EXTN..CESSPOOL, MANHOLEs 5.00 _ _ACH1�OMEN
T
PERCOLATION TEST PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
a WW A_
l
CHARGES
y
OWNER13 PER MIT 2 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
f HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO
C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC
USL!C SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS__ .DAY
OWNER OR NEW HOUSE SEWER
OWNERS AGENT -------
CONNECT ADDITIONAL
BUILD`.N G OR WORK
ADDRESS_
SEPTIC TANK.SEEP_PITS)
I HEREBY A�-KNOWLFDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
pE ABOVE IS
AND STATE THAT T' COR RECT AND AGREE To COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMB
ING ANL .SEWERS.
RS. CESSPOOL 0 DRYWELL Cl
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
NS ED AS R FOU IRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
cA W R orFORN A OR THAT I AM THE LEGAL 0 AND INTEND TO DISCONNECTPLUG AND
RES:DE IN. THE AB2,DE.lj.. RE let A L PERTY
_f
ABANDON HOU SESEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP,PIT IS) ❑ CESSPOOLS
11V VALIDATION--
4V CK. M.0. CASH
02
1 D 5 L 0-
0 3 8 7
561 E-66 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D i,%POSAL
Department of County Engineer y
County of Los Angeles BUILDING
SS -y''
JOHN A. 1_AMBIE, COUNTY ENGINEER ADDRESS —p
D CASSATT C. GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
_
FOR APPLICANT_TO—F'ILL IN _ceass sl
' —� -
7 ---OS
DLEGAL OWNER ESCRIPTION LOT NO. ^' — /' ,: ',��....: - „'✓ ..
MAIL
BLOCK TRACT
^-� :r .ADDRESS
OF BLDGS, c CITY TEL, NO.
512E OF LOT SCOW ON LOT _ d':: �E �-''
USE OF --�'°
BUILDING'- `-_ --.- ''xt *�. -DISTRICT NO. GROUP MAP
BK PG
C0� RTOF{��
T-' fid:.,- -.a✓ �"`-' -
CONNECTION DATA
STATION <_ _ - DEPTH
C1,..t'�r, _ �" i"'� �.�7EL N¢� ' ,� J. --MANHOLE REFERENCE— -- — _
Cl STATE ---- '-- -------- -- LOWER
REGISTRATION NO. ;' Q COUNTY
NO. DESCRIPTION OF WORK FEE —----- -- ---- ----- --
r�- - -- — -- - TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P y. M.L.70 F.L.
PUBLIC SEWER_ @ $3,50 -- -- -- --------
SEPTIC'TANK,SEEPAGE PIT OR---'— f - ---- ---i- __1--l—PITS-AND-/OR DRAINFIELD _ @ $3.00
OVERFLOW SEEPAGE PiT' DRAINFIELD P. C. N0.
EXiN„CESSPOOL,DRYWELL,MANHOLE @ $2..00� { CO. IMP.NO, JOB N0.
—�—HOUSE SEWER CONNECTtNr,TO I — -- ---� --------'------- —
f PRIVATE DISPOSAL SYSTEM (c-v _$1_.00I TRUNK PERMIT NO. _ __ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR — I STATE ENCROACHMENT- --
-__ WORK TO HOUSE SEWER_---. (a) $1_.0_0 _ _ _PERMIT
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM tu, $1.00 INDUSTRIAL
_ _. ._.-- ------.____--- WASTE APPROVAL
---)-----------.�__—._—__� CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT — t —pp -- — ---- — - --------
f �/..-= REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE > �.
I HAVE AT THIS DATE A CONTRACT WITH THE..,,REREIN NAMED CON- APPROVALS , DATE �INSPECTOF'SSIGN4"PURE
TRACTOR TO CO4SE �
THE ABOVE DESCRtBpt EXISTING DWELLING,
TO THE PUBLICst -. NEW HOUSE SEWER
SIGNED 7HISF r -- ---- ---------- - -- - --- - —
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK _ ----
OWNERS ---
AGF'N
-1, !,.`w L ,• SEPTIC
—IC TANK'-, SEEP,P.
T(S)
ADDR - ----��
----
AND/OR DRAINFIELD
I HEREBY ,ACKNOWLEDGE THAT I HA,Yr READ THIS APPLICATION CESSPOOL�� DRYW ELL❑ {
AND STATE THAT THE ABOVE IS COR T AND AGREE 'To COMPLY _---�_—__.
WITH ALL COUNTY ORDINANCE'S AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGEDISPOSAL SYSTEM
HEREBY CERTIFY THAT I ,AM PROPERLY EGISTERED AND/OR -DISCONNECT PLUG AND I
LICENSED AS RE04"ED BY LOS ANGELES C0; TY AND STATE OF A1:3ANDON HOUSE SEWER_
CALIFORNIA flR 5Ar°A, P;± THE LEGAY NIR OF THE ABOVE
E --— --- --- !- --
DESCRIBED RfA t PRT' BACKFILL SEPTIC TANKS❑
SIGNATURE r'f >� x w'�;,d -� _SEEP.PIT(S) [I CESSPOOLS )
OF PrA,FIT �G-_..`! m�.- 6� 4 L. '-_ ---- — — '-1----—
IOHN,A.LAMBIE, COUNTY EN EER VALIDATION ROBERT A. WOOD, GRIEF PLHO. INSPECTOR
i CK. M.0. CASH r 4 E.,