HomeMy Public PortalAbout9220 LONGDEN AVE_Sewer__ 16A 642° ° " APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING j
ADDRESS
LOCALITY y
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESRIPTIONLOT NO. OWNER
_._ MAIL Ic
BLOCK TRACT ADDRESS NO. OF SLOGS. ✓ /y .� G'
SIZE OF LOT NOW ON LOT CITY y NO.
USE OF
BUILDINGS DISTRICT NO. G UP BK AP,AP PROCESSED BY
y,�
CONTRACTO-R Y - -
ADDRESS I� -. Y CONNECTION DATA
CITY Z y L. NO. o STATION DEPTH
UPPER
STATE y t LI MANHOLE REFERENCE
LICENS NO.. CLASS _ LOWER
NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER 0 $7.00
P.C.NO,
SEPTIC TANK,SEEPAGE PIT OR JOB NO,
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO.
HOUSE SEWERCONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. D.
PRIVATE DISPOSAL SYSTEM 53.00 O
CONNECT ADDITIONAL 8N0Nli&R AFFIDAVIT WAIVER EAS[MENT RECORD. INSTI7.NIODATE V
WORK TO HOUSE SEWER $3.00 `+
OVERFLOW SEEPAGE PIT,DRAINFIELD D!
EXTN,.CESSPOOL.DRYWELL. $5.00 HWY.QRST.WIDENING O
.
ALTER.REPAIR OR ABANDON HOUSE F-
SEWER OR DISPOSAL SYSTEM @ 83.00 ,� .' u
STATE ENC ROACH MENT !y, 0+
MANHOLE 0 $7.00 PERMIT NO. s
— - --- - INDUSTRIAL -17 Z
WASTE APPROVAL /tJn
OWNER'S PERMIT $ 31 00 CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE-
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER ;7
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PIT(S)AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS.ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 Ao THE,LFGAL OWNERF.F. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE YJ
ESCRID RESID� TI/y[ PROPERTY. ABANDON HOUSE SEWER
SIGNATURE /_,.
BACKFILL SEPTIC TANKS ❑
OF PERMITTEE6 ❑
SEEP.PIT(S) ❑ CESSPOOLS
VALIDATION CK. M.O. CASH
i.:t lUo 7 P, /1 t`S > 27
CE601
cE1-57 APPLICATION FOR PERMIT
Z
eo8�a t
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINGADDRE
JOHN A. LAMBIE, County Engineer —
CASSATT D. GRIFFIN, Supt o4 Building p
LOCALITY
NEAREST
FADDREESS
OR APPLICANT TO FILL IN _CROSS ST. p; -;
DESCRLEGIPTION LOT NO. OWNER
MAIL
BLOCKTRACT _ADDRESS
EG
NO.OF BLDGS,
SIZECT NOW ON LOT CITY TEL.H0.
GS r' s � ---�' DISTRICT NO. GROUP MAP
- -SK PG
TOR°.. r ! ,.Jt{dy,
, r �¢^ CONNECTION DATA --
S"% , - TEL.N0. ';.--� STATION DEPTH
(� STATE. MANHOLE REFERENCE ATION NO.J �" []J'COUNTY LOWER
NO. ! DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $9 d3 — ---.---
SEPTIC TANK,SEEPAGE PIT OR TYPE OF!.Er€PNECTIpN LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 — �1C•�t'CURS P.L. M.L.TOP.L. _ �
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL,DR_YWELL,MANHOLE @ $2.00 _
HOUSE SEWER CONNECTING TO I P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB No.
CONNECT ADDITIONAL BLDG,OR --
WORK TO HOUSE SEWER @ $1,00 TRUNK PERMIT NO. ROAD PERMIT NO. "
ALTER,REPAIR OR ABANDON HOUSE - -
SEWER OR DISPOSAL SYSTEM @ $1 0, STATE ENCROACHMENT
_PERMIT NO.
INDUSTRIAL
`HASTE APPROVAL
_ CHARGES
OWNERS PERMIT $ I 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
-I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ( DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SE ER.0 � — ----
SIGNED THIS DAY OF ' `s' �I9 NEW HousE,SEWER i
OWNER OR / _ CONNECT ADDITIONAL
OWNERS AGENTI.. `' - - BUILDING OR WORK
ADDRESS f � - "�a � Ld SEPTIC TANK,SEEP,PIT(S) �—
AND'OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE .ABOVE IS CORRECT AND AGREE.TO COMPLY' CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCE$ AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGEDIAIR,S SEWER
I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - - ------ -
STEM
LICENSED AS REQUIRED BY LOS ANCEIE- OUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT M THE LEG�YL WNER OF T}IL• ABOVE __ABANDON HOUSE SEWER
DESCRIBED RESIDENT'' L P tOPERTY BACKFILL SEPTIC TANKS[I !
SIGNATURE. ����,, ,_ �' _SEEP.PIT(S) ❑ CESSPOOLS�-1-OF PERMITTEE
ZIP ---VALIDATION ROBERT A. WOOD
CR. U.0.. CASH SUPERVISING MECHANICAL:ENGINEER
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