HomeMy Public PortalAbout9227 LONGDEN AVE_Sewer__ DEPARTMENT OF OOUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION ZpQ3
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS !?2G,
FOR APPLICANT TO L IN LOCALITY
BUILDINGNEAREST
ADDRESS t CROSS ST.
LOCALITY alt0y
DISTRICT N0. SERIAL MO. PERMIT N0,
NEAREST A S
CROSS ST.
. RECEIVED BY Ready.tor Inspeetloq 04TE ISSIJD
OWNER � s
AAIL
DDRESS ` USE ZONiV OCCUPANCY
BK PG
CITY TEL.NO: "', / • �
CONTRACTOR CO.IMP:NO. 12 -77
ADDRESS JOB.NO. -
C TEL.NO. TRUNK PERMIT N0: --
REQIST_ ION NO. /Oil �. STUNTY ROAD PERMIT ND.� / � J
LEGA
DESCRIPT ONS LOT STATE ENCROACHMENT
PERMIT NO.
BLOCKTRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT # O.OF BLDG&
NOW ON LOT CHARGES
USE I
BUILDINGS CONNECTION CHARGE ME
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NO. _-DE-13 412TI.O:N OF-W.O.R1C- _EEJF_ REIMBURSEMENT-FEE-- -
HOUSE.SEWER CONNECTING TO
PUBLIC SEWER G $ 3.511 C) RECEIPT NO. ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCE ION CORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING, NO.J DA I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SCPTIC TTANK,SEEPAGE PIT OR - .
PITS AND./OR DRAINFIELD 2A0 STATION DEPTH
CESSPOOL-DRY W EL L
SPECIAL CONDITIONS ONLY 2.00MA PPE REFERENCE
TYPEno-UR-85-
CTION LENGTH FROM 0,OWNERS PERMIT ; I g , -Y �"`� CURB A:s M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
CONTRACTOR T0. CONN CT THE ABOVE DESCRIBED EXISTING, APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TAEjP ELIC SEWER
SIGNED THIA. DAY OF.. _ Ig__-,__ N):W HOUSE SEWER .;,.J7�}�
@ONNECT ADDITIONAL
OWNER OR aB
OWNERS AGE T __ 1.....:. _. I UILDINO OR WORK
SEPTIC TANK,SEEP..PIT(S)
ADDRESS....................:.._,........:.. ._.........._.-... ............ .... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI-i CESSPOOL[] DRYWELL I]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE'
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS' ALTER.REPAIR,SEWER OR.
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSALSYSTEM
I HEREBY-CERTIFY THAT I AM PROPERLY REGISTERED] DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY' ABANDON HOPLUGAND
AND STATE OF CALIFORNIA ORT T 1 AM THE LEGAL OWN.1
ER OF THE ABOV ESCRIBED ENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP:PIT(S)[] CESSPOOLS
SIGNATURE '�
OF PERMITTEE f. ..... .. .... .......
70AG49D 063. 1/53