HomeMy Public PortalAbout9443 LONGDEN AVE_Sewer__ _E808 3
7CAC42D 52 APPLICATION FOR PER41T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
A r
DRESS
JOHN A. LANMIE, County Engineer
WILLIAM A. JENSEN, Supt of Building L�CALITY
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PERMIT NO.
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_�WASTE PPROVAL
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' —2T 01?
CHARGES
i ION CHARGE FEE
AUTHORIZATION TOTAL FEE CONNECT
I HAVE AT THIS DATE A CONTH.RACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
F�CT THE ABOVE DESCRIBED E XISTING DWELLING
TRACTOR To I-ONN
TO THF P US L IC SEWER. DATINSPECTOR'S SIGNATURE
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SIGNED TIS APPROVALS E:
OWNEROR NEW HOUSE SEWER
OWNERS AGENT—-
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS - ------ -.---_ -- ;-----:---------
SEPTIC SANK.SEEP PIT(S)
IL
HER ACKNOWLEDGE THAT I HAVE READ THIS APP:., AND/OR DRAINFIELD
II
ANDSTATE THAT THE ALOVE 15 CORRECT AND AGREE TO COMPLY
011TH ALL COU ORD!NANCES AND STATE LAWS RFGULATING
e - I V.E CESSPOOL I.-j DRYWELL ❑
PLUMBINS' AND SIV._Rs,
HERESY CtR NT I AM PROPERLY REG157ERE-LO AND/OR ALTER.R5.PAIR,SEWER OR
Ll 1: LOS A11GLrS1,COUNT1 AND STATE OF SEWAGE DISPOSAL SYSTEM
AT
'DA BY
M THE L NE�FP Af.40 INTEND TO
*Al NT DISCONNECT PLUG AND
* ;IbE IN, T#r kBOVE DES'.'RIBiD R6FERTY.
1 11, ABANDON HOUSE SEWER it
EE
*iG NATURE C'C e-- BACKFILL SEPTIC TANKS
OF PERMITTEE SEEP,P11(5) ❑ CESSPOOLS
VALIDATION - ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
_E801a 3-62
76A642D APPLICA-fid FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
'LD INI
GRESS
JOHN A. LAMBIE. County Engineerfi
WILLIAM A. JENSEN, Supt of Building
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LOCALITY I T Y 77
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SIZE OF LOT N LOT TEL. N 0,:!
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CITY C TEL- 'ST ION i�, DEPTH
STATE UPPER
_REGISTRATION No. El COUNTY MANHOLE REFERE Ka
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TRUNK PERMIT NO ROAD PERMIT NO.
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@ $3.00
PRIVATE ALS YSFE M
FI.AVIT1WAjV`9k-f-I,AS¢NT RECORD DATE
CONNECT ADDITIONAL BLOC—OR IF A5
WORK TO HOUSE SEWER 5;3.00
OVERFLOW SEEPAGE PIT 0 RA;N F:ELD
EXT'N..CEE-SPOOL.I-RYWELLM-,NH(JLE:@ %5,.00
HWY OR ST,WIDENING
ALT R:REPAiP,OR ABANDON HOUSE 1 z
eE;--- ------- --,--- A
SEWER OR V(VPOSA'Lo�,S�ST� $3,00 - -TE E:N AC
------ ST ,�;R HMEN
PERMIT NO.
INDUSTRIAL
_WASTE APPROVAL
CHARGES
Ovmws PERMIT
CHARGE FEE
TOTAL FEE
AUTHORIZATION
I me
I HAVE AT TH'S DATE A CONTRACT WITH 114E HEREIN NAMED CON- REIMBURSEMENT FEE
T
TRACTOR O CONNECT THE AE3CVE DESCRIBED EXISTING DWELLING -------
To THE
PU OR'S`it GNATURE
, B LIC SEWER MALS DATE NSPECT
SIGNED TH IS --r)AY,wv-
OWNER C P. _NEW_HOUSE SEWER
OWNERS
CONNECT ADDITIONAL
B�;ILDING OR
WOR It,
ADDRESS------
SEPTIC TANK.SEEP.PiT(S)
HrR19V ACKNOWtFDGE THAI I HAVE READ THIS APPLICATION AND"OR DRAINIIEL..
AMD STATE THAT THE ABOVE. IS CORRECT AND AGREE 10 COMPLY
WIT AWS REGULATING
PLUMBING L COUNTY ORDINANCES
AND STATIF L
INC AND SEW FRS. CESSPOOL Lj DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR
LICENSED AS, RF�W54RED 13Y �-OS ANGLES COUNTY, AND STATE OF SEWAGE DISPOSAL SYSTEM
W
,FI'1t;F1 AND INT DISC
, T _p -
.E c F END TO CONNECT PE AND
C A.X��`T )T I A- F -'I-G A 'p
VE I. -11t_ N
RESIDE IN �W. F.`�H.I.E. 11 ABA CN HOUSE SEWER
OF PFRMtTTEE BACKFILL SEPTIC TANKS
SIGNATURE 7
SEEP PITS) CESSPOOLS
VALIDATION ROBERT A. WOOD
CK. M.O. A-$.I SUPERVISING MECHANICAL ENGINEER