HomeMy Public PortalAbout9449 LONGDEN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SURIT OF BUILDING ADDRESS
FOR APPLICANT TO, FILL IN LOCALITY
BUILDING � r, F �F `" NEAREST
_ADDRESS � _ a✓"_ _ t' =" CROSS ST.
LOCALITY
f�' - DISTRICT NO. SERIAL NO. PERMIT NO.
`� �-�� �. -
NEAREST A S_
CROSS 5T r RECEIVED BY Ready for inspection DATE ISSUED
OWNER ------
MAIL a Y USE ZONE OCCUPANCY MAP
ADDRESS ` G _:_. � � BK PG
L°
CITY k TELAO. 4
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS REQUIRED
------ -- -- - NOT REQUIRED _
CITY TELNO.
JOB NO. CONNECTION.CHARGE FEE
STATE CO-IMP.N0.
REGISTRATION NO. COUNTY
LEGAL _ RECEIPT NO. I DATE 1 BY
DESCRIPTION LOT N0.
BLOCK TRACT WAIVER FOR RECORDING
SIZE OF LOT NO.OF BLDGS. .�ti RECEIPT NO. DATE- !BY
_ NOW ON LOT .
USE OF
BUILDINGS TRUNK PERMIT NO.
NO. DESCRIPTbON OF WORK FEE - -
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLICSEWER @ $ 3.50 - ----
HOUSE SEWER CANNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 { PERMIT NO_
CONNECT ADDITIONAL BLDG.OR I INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
DISCONNECT AND ABANDON SEWER "—
_ AND/OR DISPOSAL SYSTEM 1.00 ? STATION DEPTH
SEPTIC TANK.SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
---------------- -
CESSPOOL—DRYWELL i UPPER - LG?HEE.i>v-%-_I'�a. - -
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM
Y. CURB - P.L. M.L.TO P.L.
OWNERS PERMIT $ I 1 00 -
AUTHORIZATION TOTAL FEE
IHAVE THIS DATE CONTRAED WITH THEAED
CONTRACTOR TO CONNECT THE ABOVE D SCRIBEDIEXIISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..;`,. -.-...DAY OF,� •---..---,....l99 NEW HOUSE SEWER
OWNER OR' / CONNECT ADDITIONAL
OWNERS AGENT " y t BUILDING OR WORK
� +� �`• SEPTIC TANK,SEEP.PIT(S)
ADORES S 1'" _ 1 AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I H i `'READ THIS APPLI-' CESSPOOL E] DRYWELL
CATF .
ION AND STATE THAT THE ABOVEYS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING CERTIFY'THAT
SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY` THAT 1 AM PROPERLY, REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES GO UNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNI OR THAT I AM THE LEGAL WN-
ER OF THE ABOVE DESCi{ BED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS
� —�
s' SEEP.PIT(S)E] CESSPOOLS
SIGNATURE
OF PERMITTEE---- -..----------- -----
i 6A642D 663 12/52