HomeMy Public PortalAbout9157 LONGDEN AVE_Sewer__ 76A6420 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING r -
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT Or BUSLOING LOCALITY ,
FOR APPLICANT TO FILL IN NEAREST
CROSS
LEGAL -
DESCRIPTION,__ LOT NO, OWNER
BLOCK TRACT MAIL -�__ -�-_-
_.-_,__ ADDRESS ;
NO.OF BLDG§
SIZE OF LOT NOW ON LO CITY' 'TEL. NO. "
USE OF
Y DISTRICT N0. GROUP MAP
BK PG
i
CONTRACTOR % ✓ �
aDDREss_...;,,. _ _—M..—. CONNECTION DATA
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CITY TEL. NO. e STATION DEPTH
UPPER
.STATE MANHOLE REFERETcCE _.
REGISTRATION NO. / 4.> :, / ,� COUNTY .'- .,."..
NO. DESCRIPTION OF WORK FEE —T
NO
_ }IOU.SE SEWER CO}vNECT'.NG TO - , - TYPE OF.r`ONNECT10N LENGTH FROM
.�-_�. FU8LiC SEWER ry $ 3.50 CY, P-L,_ M.L, TD P.L.,—
— HOUSE SEWER CONNECTING TO
i
PniVATF D 5POSAL SYSTEM _ 1,00
I 'CONKicT ADDITIONAL BLDG. OR P. C. /0.
WORK TO HOUSE SEWER _ 1.00( .CO._IMP. NO. ...:�� JOB NO, _
ALTER OR REPAIR EXISTING _-- TRUNK PERMIT N0, ROAD PERMIT NO.
O.
SEWER OR DISPOSAL SYSTEM _ 1.00 _ _
DISCONNECT ANDA 30
dL'ON SEWER^
Ai3D/OR DISPOSAL SYSTEM � i.00( STATE ENCROACHMENT —��- -- —
SEPTIC TANf SEEPA.E FST UR PERMIT NO.
F[rS
AND/OR DRA NFIE.LD .2,00 — INDUSTRIAL
CESYWE
SPOOL DRLL f 'f- WASTE APPROVAL
SPECIAL CONDIT10NS ONLY 2.00 t CHARGES
T— CONNECTION CHARGE FEE
OWNER'SPERMIT $ h CD --- — --- - -- - -
A7JT135.d[lIZS3T OaV TOTAL FET; ( v' _ REIMBURSEMENT FEE
—!
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CO^N- APPROVALS s DATE INSPECTOR'S
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING_DWELLING �
TO THE PUBL C SEWER -
-°' NEW HOUSE SEINER - -
SIGNED THIS —DAY 0�
OWNER OR CONNECT,ADDITIONAL `�f~
OWNERS AGENBUILDING OR WORK_ i
SEPTIC TANK. SEEP,P}T(S)
ADORE ANDJOR DRAINFIELD _
-I HEREBY RCKNOW4EDGE THAT I HAVE RCAD T4iIS APPLICATION CESSPOOL❑ DRYVVELL D
AND S"FATE THAT THE ABOVE IS CORRECT AN.{ 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 ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I ,A7 THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTI-AL .PROFERTY. BACKFILL SEPTIC TANKS 0
SEEP. PIT(S) ❑ CESSPOOLS[]
SIGNATURE _ ---- — - -- -OF PEPMITTEE,._ a p y
WILLIAM OX,COUNTY ENGINEER 7 VALIDATION ttR.A.WOOD•CFfiEFtP^LBG. INSPECTOR
14
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