HomeMy Public PortalAbout9152 LONGDEN AVE_Sewer__ 76A1,420
a•ss APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOQSAL.
Depo`rbnent of County Engineer _
County of Los Angeles ADURESSG
WM.J. FOC, COUNTY ENGINEER --
CASSATT D.GRIFFIN, SUP'T of BUILDING LOCALITY a
FOR APPLICANT TO FILL IN NEAREST
_ CROSS 5T. A`__ �• -
DESCRIPTION LOT N0, „+'' �...✓' _ OWNER,
_.
BLOCK - TRgCT MAIL �._.�..._
BL6G5.
SizE OF .,NOW ON LOT �.{_,.. CITY - NO.
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BUILDINGS"'s w..�L" - `DISTRICT Nq
GROUP I MAF'
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CONTRAet' f�!. ,w' F, �"`.fr«-t._.�',: :: ✓`'' - ._...:...V
:Aum ; _y". CONNECTION DATA
TEL. t i`g'> 3_ STATION Y DEPTH
,� [I, STAT MANHOLE REFERENCE UPPER
REGISTRATION NO. + >' (_i, COUNTY
N DESCRIPTION OF WORK FEE
"--�'—�— - TYPE OF CONNEC 1 LENGTH FROM
HOUSE SEWER CONNECTING TO ( _- y, P.L,
PJ3LIC SEWER_ � CURB �
. g 3.50! `--- --- R L 'O PL.
--- --'--i
I HOUSE SEWER ER CONNECTING TO
_�I __—����
PRIVATE 15'tOS L SS FTEM 1.00
r CONNECT ADDITIONAL BLDG. OR -- - �" P C N0.
Jti
OR K TO HOUSE SEWER__ f.GO ., CO. IMP, td
ALTER OR REPAIR EXISTING
;EWER OR D'SPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD.PERMIT N&.,'
UI�CONN CT ANC ABANDON SEWER STATE ENCROACHMENT--y ---i �----^-�
AND/OR DISPOSAL SYSTEM i,CD
`� (,(•;S—SP0__T_� ___ P RMIT NO
PITS DRAiN 2.00 INDUSTRIAL
5EPfIC TA K,SEEPAGE PIT OR WASTE APPROVALOL-ORYWELL
s --.—- -------
- �..
SPECIAL CONDITIONS ONLY 2A0�
---_.N _ GHAI2GS
CONNECTION CHARGE FEE +"
OtYs —p1zIT r� �, �
r�rQ . __- — — ---- ---
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AUTHOMATION TOTAL FEE `r REIMBURSEMENT FEE
I H VF THIS DATE CONTRACTED WITH THE HE. -IN NAMED CON- a,�,;9 yyr�p
TRACTOR. f0 CONN"' T THE ABOVE D ,l8ED STING DWELLING APPROVALS DATE^�i.NSPECTOR'SSIGNATURE I
TO YE PUBLIC SE/WS' f - —.-..—.—... --- ------'---'-3
NEW }LOUSE SEWER {
S1Gf1ED 'C. iS �9 Gt1Y
OWNER 'O .•.'� ° CONNECT ADDITIONAL
UILOING OR WORK
y�—
0WmrRS WORK
kDDRESS "• y .:�/ '�=./ "�+' SEPTIC TANK, SEEP, PIT(S)
_ AND/OR UPAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE RFF�D"THIS APPLICATION CESSPOOL[IDRYWELL[I
AND STATE. THAT THE ABOVE IS CORRECT/ND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE,S. AND S ATE LAWS REGULATING
PLUMBING AND SEWERS. R
SEWAGE DISPOSAL SYSTEM
1 HEREBYCERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND !f
CALIFORNIA OR 7.HA1 I AM T = LEGAL OV'S:L OF THE ABOVE _ ABANDON HOUSE SEWER I
DESCRIBED P.,ESIVNTI L PROP•E TY - ,N/ BACK ��—
=-""`;l ✓ .;,F- ✓. KS
SEEP.rPIT(S)ILL 0ICIC SSPOOLS[i ---
SIGNATURE
OF Pp.
WIL IFxP6+I J.FOX,COUNTY ENGINEEd VALIDATION R.A.WOOD. CHIEF PLEG. INSPECTOR
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