HomeMy Public PortalAbout9221 LONGDEN AVE_Sewer__ iLk E-6311.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER - --
3 CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY ?`
— ( I
_ FOR APPLICANT TO FILL .IN NEAREST
1_ ,T _CROSS ST ir
LEGAL
DESCRIPTION LOT NO ''� OWNER
e _
BLOCK _ ..a„ TRACT i I - MAIL
ADDRESS ..
NO.OF BLDGS. CITY TEL. NO.
SIZE OF LOT' _ NOW ON LOT _
USE OF � -- ,��—'----- DISTRICT N0. � GROUP MAP
BUILDINGS BK PG
CONTRACTOR r r Jlr. ,y� - .,s✓ L;�'-
- CONNECTION DATA —= --
ADDRESS -
--- -
CITY.- r Ti ,�-kE . �' p -V �, _STATION - � DEPTH
L. NO
1.-e>--= -q-p `v�--� '•�-�a'�-,.•— - --'— r. r' a _i' MANHOLE REFERENCE
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STATE .._. _,.�'� -`.d'°7 _.� -Ow :✓
REGISTRATIONNO-. ' yL- COUNTY — --� --- -
NO, i DESCRIPT]DN OF WORK FEE - -- --- -
TYPE OF, " ECTiON - LENGTH FROM
f HOUSE SEWER CONNECTING TO i Y CURB= _,9;$As! M.L. TO P.L.
;7 PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
_{ PITS AND/OR DRAINFIELD (2 $3.00
i UVERFLOVd SEEPAGE PIT,DRAINFIELD — I `---" ""'" P. C. NO,
EXTN.,CES2.
CESSPOOL, @ $ 00 CO. IMP. NO./ �. . .Po�'� JOB NO.
PRIVATE DISPOSAL SYSTEM cf� $1.00
HOUSE SEWER CONNECTING TO -
' � TRUNK PERMIT NO. RGPD PERMIT
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO-HOUSE SEWER _ (if_$t.00 � _ _ _PERMIT NO.
----
ALTER,REPAIR OR ABANDONHOUSE --- --------- - —
- 1 INDUSTRIAL
SEWER OR DISPOSAL SYS'TEM (cl: $1.00 _ WASTE APPROVAL
--j-"-------- ---- --- -- CHARGES
,.. --- CONNECTION CHARGE FEE
OWNER'S PERMIT -- ---- ----.---
AUTHORIZATION TOTAL FEE - REIMBURSEMENT FEE
.%
APPROVALS
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONS __ + D-ATE �INSPECTOR'S SIGNATURE
_ VALE _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -
TO THE PUBLIC SEV ER; NEW HOUSE SEWER
SIGNED TH!S .k DAY OF--'- 19 i�y --
CONNECT ADDITIONAL
OWNER OR. "; - BUILDING OR WORK 1
OWNERS AGENT-
SEPTIC
----- ----- -. -___ —i--
SEPTIC TANK,SEEP PIT(S)
A-DDRESS--_ AND/OR DRAI_NF1EL0-_-- ---i_. -I----
' HER BY ACKNCWLF,DGE THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL'1
AND STATE TnIAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL CGUN1Y ORDINANCES AND STATE LA:J5 REGULATING ALTER,REPAIR,.SEWER OR
PLUMBING ;;ND SEWERS. SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED ATE OR DISCONNECT PLUG AND j
CALIFORNIAAS REQUIRED BY LOS ANGELESLEGAL
COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNOR -CHAT,:I AM THE LEGAL OWNER OF THE ARGUE
DESCRIBED RE`IIDENI9zj'L PROPEkl"Y. BACKFILL SEPTIC TANKS'(_
SIGNATURE - j' ." SEEP.I I (Si Ll CESSPOOLSLi ------- -------
OF PEPMITTEE
JOHN A. LAN*IE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. 3i.O.