HomeMy Public PortalAbout9439 LONGDEN AVE_Sewer__ b„
71A6azJ O APPLICATION FOR P RMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F�111'NG
J013N A. LAMBIE, County Engqineer Es �WILLIAM A. JENSFN, Supt of BuildingFOR S7UEGRR
CROSS ST
CESCRSP71 n'ry LOT v. .-- OWNER
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AD'
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NO. OF BLDGS, -
SIZE OF LOT NOW ON LOT' .CITY ...' �^'
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USE OF �{//
BUILDINGS' �+ '6-�'+?6'�...,g'- DIS7H!CT NO, GROUP MAP PROCESSED BY
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CONTRACTOR '� ? 92
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ADDRESS CONNECTION DATA
STATION y` y DEPTH
TELT NO. L fj'J', {,
^�,,ds LJ TATE
MANHOLE REFERENCE
REG I57RA7tON NO. d A [] OUNTY y!! 1' ` - �v
LOWER
NO. DESCRIPTION O WORK FEE
-. -_ -._ TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO - Y `
>✓ I CURB P L M.L iO P.L, �.
_�PUBLtC.SEWER- _ @ 3S.00 -------1. - --- ----- JOB NO —�
SE.PTfC TANK $EEPAG PTT 7R '-f
PITSAND OR RAINFIE'LD $10.Dt3 I Co.IMP NO
H OU SF'SEW R CON NEC'J NG TQ -- --
TRUNK PERMIT NO. ROAD PERM DT NO ill{ 1
PRWAYEDISPOSAL SYSTEM@ $3.00 I
— ——i --- —
CONNE.C.' ADD TtONAL BLDG OR AFFIDAVIT WAFY6R raSEMEMT RECORD.1N$TF N.O. DATE
WORK TOHOUSE."sEW ER L $5.00
OVERFLOW SF?PAGE PIT.fSRA NFIELD I I
;EXT N.. S: W'
CESPO0L,ORYELLH
.,MANOLE @
$5.00
-___
1.LTFR. AIR OR ALA NDON rdOUSH � HWY. OR ST.WIDENING
tlSEW RORu)SPOSALSYSTEM @ $3,
---_-_
STAT-ENCROACHMENT
„_..
PERMIT NO,
WASTE APPROVAL
-
OWNERbS PERMIT 2: oo --- —_ -__ _ --._--- -- ___--
_.. --_ --._-- CONNECTION CHARG'EPEE
AUTHORIZATION TOTAL FEE v _—_--------------_---____—
1 HAVE ATTHIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
---- -- -------------
TRACTOR TO CONNECT THE APOVE DESCRIBED EXISTING DWELLING --- -- - - ----- --- r- -- ----- - - ---- - --- ---
TO THE F''UBL IC SEWER APPROVALS D=1TE i-.1ECTOk S SIGNATURE
SIGNED THIS DA F—t ,__—.-- -
OWNER OR NEW HOUSE SEWER.
OWNERS AGENT___—. CONNECT ADDITIONAL —.-
-- BUILDING OR WORK 1 I
S€PTiC-LANK..SEEP,PI"f;S)
I +-IFREBY ACKNOWLEDGE THAT i HAVE. READ THIS APPLICATION - i
AND.,OR DRrLINFkELO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH
ALL COUNTY ORDiNAN',ES AND NATE LAWS REGULATING
PLUMBING. AND SE`N ERS'. CFSSPOOI_ DRYWELL L� �
1 HEREBY CERTIFY TH„/T:1 AM PROPERLY REGISTERED AND!OR, ALTER.REPAIR,SEWER OR I
{q I_NSF'Dii AS RECJ I,91@ BY LOS ANGLES 9OUNTY AND"STATE. OF SEWAGE DISPOSALSYSTEM
LI C'L:N >•D A GR I-{�+i I AM THE LEGAL> }hof? R' OF. N�JNTEND TO
,� DISCONNECT E'LUI AND
StC,NAf IJ HE 7HBOdE DE-CRIB£D R IDE 'A ld,RRCb ER7 Y.
S
j% A6AtdDON HU -5i SEWER
OF PFR -tTTEE ✓� �' � ,._,_ A.CKVILI S,PTIC TANKS [II _
SEEP.PIT iSi LJ. CESSPOOLS ❑�
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.0, CASH