HomeMy Public PortalAbout9461 LONGDEN AVE_Sewer__ 'EA(52.
18A6420 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FALDING
JOHN A. LAMBIEN County Engineer DeWILLIAM A. JENSEN. Supt of BuildingAREST—
FOR APPLICANT TO FILL IN ROS>> ST,
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DESCR PTION LOT-NO ;fiy OVdN ER yr �."9T - /A _c .-- --i-
BLOCK _ TRA-T_) A Ur'tE5
NO. OF BLOGS -
SIZE OF LOT NOW ON LOT CITY8 TEL. NO.
USE OF
BU.ILDINCS DISTFiIC7 NO. GROUP MMP PROCESSED 6Y
.ONTRACTOR /��'..y.�•y�-3
ADORE 5 � ��d ° — _ CONNECTION DATA — --
d a� kL NO. i yp „ 5TA9'iON � f/, DEPT}{
REGISTRATION N(7 7 I✓+X" MANHOLE REFERENCE
. C`JUNTY' - -TYPE OF CONh$: IVN LENGTHz -- LOWER
NO. j DESCRIPTION OF WORK --FEE _— -- - _ _ _ N � -LFROM -- _
.. I HODS S V ER CONNE CT7NG TO C Y C:}r8 P t M,L.T P L.
� NO.
PUBLICS SEWER P.C.NO,
EPFIe,Tq JOB NO.
P PS AND/i N)OR.DRAIIELD @ $70 O.O j --CO. (.M_-_--P NO s -'-..--.—
POI s SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO,
I PRIVATE D151 O5AL SYSTEM @ £3.00.
,+ CONNECT ADDITIONAL
_B__ t OR - - i--- I AFFIDAVIT' N'-AfYER EASE5i5ENT� RECORD.INS7 NO DAY E: --- QQ}Q,,,���.
i WORK TO HOUSE SEWER
O/Ei;i O Si PAG£PIT UR6Nr
XTN..CESSPOOL.DRYWELL,MA'YHOLE@ $500 .H'WY,.OR.STWIDENING
- _ 4m
A T£r?,REPAIR 077.ABANDON HOJ-E
� FN ROR
DISPOSAL SYSTEM x' $3.00 STATE ENCROACHMENT'
-�- PERMIT NO.
1NOUSYRIAL
- 1 WASTE.APPROVAL
_ CHARGES
OWNER'S PERMIT 3 2: 0 - - --- — --- ----- - - -- ---
_..._-___-__._._.. --1 .- CONNECTION CHARGE FEE
AUTHOIRIZATION TOTAL FEE
HAVE. AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ REIMBURSEMENT FEE
TR+ACTOR TO CONNECT THE'. ABOVE DESCRIBED EXISTING DW ELL IN;G -- - yy�' ---- - ---- -'-'--
TO THE YIJ BL'C SEWER. APPRV Y ALS j DATE^ l!�.IN5PECTOR 5 SIGNATURE
SIGNED THIS JAY OF_.T.------ -�9-- -'-- --- ----- -- --'-,7— --- --- ---�
I
OWNER OR. NEIN HOUSE.SEWER j
OW'NERfi CONNECT ADDITTONAL
BUILDING OR WORK -L
-- --- - -- - - --- -------------
SEPTIC TANKSSFP,PIT..-(S_-
1H RF_BY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR.D:RAINFIELD
ND
IS CORRECT AND AGREE TO COMPLY
ASTATE THAT THE ABOVE
WITH ALL COUNTYORDINANCE:_: AND STATE LAWS REGULATING+
PLUMP
AND SEWERS. CESSPOOL D DRYWEL.L r]
7 HERESY CERTIFI
Y THAT AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWEROR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE'DISPOSAL SYSTEM �
-C ALAI`ORNIA OR TH{ATA AM THE LEGAL OWNER OF AND INTEND TO DSSf:ONN ECF F_Ut3 AND - TI
RE:SIDE 1N, T'Hi,. AE5 VE°UEuCR76F,,C3 R OEN.tt PROPERTY ABANDON HOUSE S£'WLf2
SIGNATURE 1 . 11e`y
BACKF lI L_
yy �
OF PERM.1'TTEE ✓� F_PT1C TANKS j
SEF_P.,FIT(5) r GE5SP0OL,S [}��
_ 'VALIDATION ROBERT A, WOOD
SUPERVISING MECHANICAL_ ENGINEER
'J CK. e M.O. CASH