HomeMy Public PortalAbout9161 LONGDEN AVE_Sewer__ 7aEE61' APPLICATION FOR PERMIT
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DIVISIO14 OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING _
ADDRESS
WIvI.J.FOX, COUNTY ENGINEER
CASSATT b. GRIFFIN, SUP'T OF BUILDING LOCALITY ?1 -
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO,
MAIL
BLOCKTRACT ADDRESS PL`"
NO.OF BLD GS, ° z� �.
SIZE OF LOT NOW ON LOT CITY ^.< 7" {{,,-�t` TEL. O.
� -----_— 6.. ✓.. - 1 Y
USE F
BUILDINGS DISTRICT N0, GROUP MAP
BK PG
CONTRACTOR .a` ,✓"�-.
ADDRESS ,d ' ..�;.�..y rCONNECTION DATA moi.
CITY `� TEG. N0. " STATION - DEPTH
. STATE MANHOLE REFERENCz,
12 t� —_
REGISTRATION N0. r x,yf � C- COUNTY
NO. IDES"RIDTION of WORK FEE
f� HOUSE SEWER CONNECTING TO —�—�� �`-r TYPE OF CONNECTION' - LENGTH FROM -
6 Y,- -Curl P.L. M.L. TO P L._
PUBLIC SEWER CcJ+�$ 3.50 + - - - -- -- -"
1 HOUSE EWER CONNECTING TO I
_I PRIVATE DISPOSAL SYSTEM 1.0_ �__{__-
CONNECT ADDITIONAL BLDG. OR P C NO.
, €eVORK TO_H �JSE SEWER -�1.00� CO,_ IMP. _JOB NO.
--
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.DO, TRUNK PERMIT N0, ROAD PERMIT NO,
DISCONNECT AND.46AP.DON SEWER STATE ENCROACHMENT -�
_
AND/OR DISPOSAL SYSTEM_ 1.00_ PERMIT NO.
SEPTIC TANKSEEPAGE PIT OR r! W
_ PIIS AND'OR
DiNDU5TRIAL
RAINFIELD 2.00VASTE APPROVAL
� CESSPOOL DRYWELL
SPECIAL CONDiTIONS ONLY 2.00 CHARGES
----- CONNECTION CHARGE FEE
OWNER'S J PEkiIrSIT 1_0
REIMBURSEMENT FEE
AUTHORIZATION TOTAL E'E E � � ���: _ �
1 HAVE TIPS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR
ON- APPROVALS�w '-
TRAr OR TO CONNECT 714E ABOVE DESCRIBED EXISTING DWELLING A5i91 PROVALS DATE INSPECTORS SIGNATURE
TO T14E PUBLIC SEWER - — ---- --
- NEW HOUSE SEWER
SIGNED THIS--L Z.-- DAY O: ICa "--
O'dl N ER OR j
CONNECT ADD€i OVAL
y \f BU;LDING 0P,WORK
OWNERS AGENT +$�`�'- a'�3,arb�if��� � A r�%� _ -.� --
�:
ADDRESS- �P SEPTIC TANK, SEEP, PIT(S)
--. _ "_ ANIVOR DRAINFiE.LD _
I HEREBY ACKPiOWLEDGE THA HAVE READ THIS"SAPPLICATI CESSPOOL❑ DRYWELL G
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REpA1R,S'E'WER OR
PLUMBING AND SEWERS. _ALTER,,E DISPOSAL.RSSYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND j
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABGND_t }iOUSE 5E4V( R _
DESCRIBED RESIDEN $C::kROPERTY, �, BACKFILL SEPTIC TANKS G
` SEEP�PIT($j [I CESSPOOL$[�
SIGNATURE —
OF PERMITTEE. zs
WILLIAM J.F COU Y ENGINEER VALIDATION R.A.WOOD, CHIEF PLEG. INSPECTOR
' 0 1 4 G.,tin's 1'ffl 7�.5., , 1 M'