HomeMy Public PortalAbout9141 LONGDEN AVE_Sewer__ S E-6sa sr.ss D APPLICATION FOR PERMIT _ 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D POSA L
Department of County Engineer
County os Angeles
of LAeBiItLDING ' / F'" z�
ADDRESS ,^.�+`�"�.�`�>: ,�`. ••,�� .. ,':<` �:. .
JOHN A. LAMBIE, COUNTY ENGINEER --�--
7 CASSATT D.GRIFFIN, SUPT OF BUILDING
LOCALITY
1
_
FOR APPLICANT TO FILL IN NEAREST ST H
LEGAL
R:OWNER
DESCRIPTION LOT N0,` - -
AIL
BLOCK .. TR.PJ9"f $ `'-` ;(.f`;� ,`.. _ ,..;.-' _ADDRESS ,_ �•;°_`_- _ - -
a NO. OF BLDGS.
SIZE YQfa`tT W j�' 'f �` NOON LOT ,/ CITY TEL, N0. :.
USE OF
BUILDINGS _ d� ") DISTRICT N0, GROUP MAP
8K PG
CON
TRAACCjOR✓
ADD sS F - _ CONNECTION DATA
—.,
STATION DEPTH _
C-,Y ! .' -. TEL . ,p _ - -- n ------
amu.• s-_
,� -_ - -MANHOLE REFERENCE
�'` �� ❑ STATE I , SLOWER
REGISTRA/ON .O. „�,,t` ..A.�" C COUNTY - - --- - -- --- -
NO. DESCRIPTION OfiWJRh FEE --- --i—
HOUSE SEWER CONNECTING 70 I �!Je TYPE OF CONNECT ON LENGTH FROM
` L.
I PUBLIC SEWER _ @ $3.50 Y_�__ - CURB-- P. M.L.TO P,L.
-- -----_.—
i SEPTIC TANK,SEEPAGE_ PIT OR
-- - - �-
PITS AND/OR DRAINFIELD $3.00
OVERFLOW SEEPAGE PIT,DRA NFIELD P C. NO.
j EXTN_CESSPOOL.DRYWELL.,MAN HOLE $2.001 i CO. IMP. NO, -- JOB NO.:
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM (a_¢1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
j
WORK TO HOUSE,SEWER_.--._. _a $t-Or, PERMIT N0.
AL7ER,PEPAIR OR ABANCON HOUSE ----- ----------�-� '--- -----
SEWER OR DISPOSAL SYSTEM $1.00 INDUSTRIAL
-.i _._ -._. WASTE APPROVAL
I CHARGES
CONNECTION CHARGE FEE
t
OWNER'S i PERMIT ---—--- ----
AUTF'I®RIZATION TOTAL FEE I a-`F • - REIMBURSEMENTFFEE
I HAVE AT THIS DATE A. CONTRACT WITH T°HE HERE NAMED CON- APPROVALS - I DAl'E IlNSPECTOR'S SIGNATURE
HAVE
TO CONNE;THE ABOVE R€$ 'I�21BEW EX ISiING DINELLINi
TO THE PUBLIC SF,,tl�aPdi. / .,� � ,.� NEW HOUSE SEWER
SIGNED THIS,_./ DAY CONNECT ADDITIONAL
OWNER OR -' - ; � SU-1LDW
ING OR O R K
OWNERS AGENT, i✓w ` v:- - - - - - - -'- ---- ----- -- -----
I` SEPTIC TANK,SEEP, PIT(S)
ADDRESS f x,i�
AND/OR DRAINFIt LD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLD DRY'WELLE I
A^!D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
.WITH ALL COUNTY ORDINANCES AND S'iA.TE LAWS REGULATING- ALTER,REPAIR,SEWER OR
.PLUMBING AND SEy,ERS• SEWAGE DISPOSAL SYSTEM
I HEREBY CCRT;FY THAT f AM PROPERLY REGISTERED AND/ORTF DISCONNECT PLUG RPlD
LICENSED AS REQUIRED BY LOS ANGELES C+,UNTY AND STATE OF
CALIFORNIA OR 4AIAT. I R THE LE6'i, OWNER OF THE AE30VE ABANDCIN HOUSE-SEWER.-
DESCRIBED RE 1� 7.f�L P�JiRTY BACKFILL SE TIC TANKS
-?. SEEP. PITS) VI CESSPOOLS E
SIGNATURE a �`F �.l r,'s � .. - _
OF f FiitM1 & 4 �f t_ ti
IOHtN AMBIE,COUNTY ENGI EERVALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
�e CK. N' 0. CASH
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