HomeMy Public PortalAbout9465 LONGDEN AVE_Sewer__ � r
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EAr azD APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineer
ADDRESS —
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST FOR APPLICANT TO FILL IN �RQ5
G_SCEGAfIGh3 Ol"RJOj�°✓ '-� OWNER 5 Y C Y- •�- N
Z_
MAIL
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_
SIZE O. LOT NOW O.N LOT CITY ' TEL. NO.
USE OF
B QLD NGS DISTR?C.T NO, GROUP MAP P;L'+,OCESSED BY
5K PG
CONT ACTOFZ_ f +
-.._
.ADDRES5 .G !,�', ;-- ,— �. � ; , '' CONNECTION DATA f
Ct TY. _.�N'�' �: ST 4"fION r -_. DEPTH
Y r STA TE Lf'F R
REGISTRArIr3N NO " MANHOLE RTff.:RLr c.0
❑ CO_NTY
NO- r DCSCRIPTi N OF WORK FEE
TYPE
.r E OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. - C'U�}$ P.L. M.L. T3 P.t,
APdS
PUBLIC.SEWER _� $S.OD
P C-NO.
r SEPTIC TANK SEEPAGE PI'i OR I
I CO IMP JOB NO
P 7 F{AND/CDRAIN tCLD $10:00
NO
HOUSE SENlrR CO'NNEC TING TO I TRUNK PEP.-MIT NO. T� OAD PERMIT IVO. Ind
PRIVATE D 1-O SAL SYSTEM @ $3.00
__- .'-_-
F -4-
.-
_ �..,._ _4--_ DATE
:. SEC AJCI 'ONal BLDG 4R AFFIDAVIT Wa vE& EASE RD NSTR NC.
---___ $a.p0_ _.__ _____ HWY.OR S7.WiDENING
WORTS TO HOUSE SEWER � $3,00
-� O ERELOW SEE PACE PIT,DRAINFIELD
EXTN,CE POOL,DRYWELL.MAN OLE L.
A�'"ER,REPAIROR ASA NDON HOUSE' _
SPY,'Ell O'�D;SP'OSAL SYSTEM $;x.00. _TA_.—..E
-._ STE NCROACHMENt' -
PERMI'�No
-
WASTE APPROV
z
RMIT . oo
OWNER'S PE -, ' -- ---- - - - - ----
-_... __._--.___ CONNECTION CHARO:"
AUTHORIZATION TOTAL FEE -- ..
, HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- REIMBURSEMENT FEE----- - ------- --
7-ZACTOR 70 CON NEC:T THEABOVE )DESCRIBE[) EXISTING DWELLING. - --__---_ _/_y
70 THE PL HLlC SEWER. APPROVAL ;"ATE INSPECTOR'S SIGNATURE.
SIGNED THIS.--.—BAY OF __--. _19—
--_.
OWNER OR NEW HOUSE EWER
OWNERS AGENT—— ..-.____ _..._...—
CONNECT ADDITION, I
BUILDING OR WOR Y.
_. AND/OR
TAMS NEEP,FAT(G)
EY/
I HERBY ACN C. .�
WEOf THAT 1 HAVE READ THISAND/
APPLICATION OR DRA.N19 EL D ,
AND STATE THAT :HE ABOVE .S CORRECT AND AGREE TO COMPLY
WiTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMS ING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTi FV THAT I AM PROPERLY REGI STERED AND/Oft ALTER.RE AIR,.SEWER OR i
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF' SEWAGE DISPOSAL SYSTEM
-ALIFORNIA OR THAI lATHE LEGAL C ER OP, AND INTEND TO O DISC UN NErT PLUG AND
ESiDE iN, T -
R: Hc AH E D S:;.RIHED R-^ fI PROPERTY. ABANDON HOUSE SEWER
SIGNATURE �-
OF PER M.ITTEE.+'a- BACKFI L Bk PTIC TANKS ❑ �.
SEEP,PIT,
S7 ❑ CESS POOLS i
,v VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
: K i/ M.0.. CASH
'.15A542D APPLI.CATIC)k FOR PERMIT'
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BU rL DI N0
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. IErdEN, TMaup`t of Building
Ply *
I OCAL7TY
NEAREST
FOR APPLICANT TO FILL IN `Ross T
._LEGAL
DESC'RIPT ON LOT NOY' ' ./ OWNER
.�' ,�✓` MAIL
SLOC�K t7 TRAc J r�l'.P�"�'. '6. /�/"�'�. .. 'r i'aY ADDRESS
?d0.. OF BLDGS. ,»
SIZE OF LOT NOW ON LOT CITY Y� TEL.. NO,
USE F
DISTRICT NO. GROUP MAP P-R QC ESS ED BY
BJILblN< SK
GO NT
RALY C
5.�..Lz!,ic
I F,
_
ADDRESS � �y' �� � -- � �?� CONNECTION DATA
. -_V..-Y �"y _.✓�. j� L.-nt7T b` s'._ S? a°" bY9.7:ON _ DEPTHTF MANHOLE REFERENCE'
CJ U F.'r^E47
RE ;,I NO. ^z-
�.:..e� ._.__ -_ COUNTY W"E4
-_--__
be DESCRIPTION OF WORK FEE TYPE OF CON'.E'.T1GN LENGTH FROM
i101 E 'FWERCONNEt TING D Y g'� P.L. M.L.TO P.L.i
PUBt
C SEWER $5.00 0
PT IF,TANK SEEPA ESi7 OR --- P NO r
Co.TMP B O.
PI AFFD/OR DRAIFlh fF r` @ ,'01000
HOtJ SE SLWER CONNECTING TO TRUNK PERMIT NO ' ROAD PERMIT NO `
PRiVAT
H
C 71N TE C001TL SNNJ RLD.� OR AFFIDAVIT wn;vec I ASENChT REc:ORD iNCiYP C NRAVE ._..-
�.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EATN.CESSPOOL.RRY�VELL,MC.Nj4f0, @ .
LE - 55.00
_. _ —__-�_._.—. H'dJY.OR.ST,WIDENING
ALY R REPAIR Of?AYiAN DON y1[J{1.aE
FWER OR DISPOSALS / /u, 63.00
-_:_ STATE ENCROACHM ENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWND S FERMIT
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
i HAVE AT THIS DATE A CONTRACT WITH THE HERFiN NAMED CON- REIMBLiRSE.MENT FEE
"TRACTOR T2 E'.(>+YN ECI' THE ABOVE DESCRIBED EXISTING DWELLINv ____. - {y_-_. _ T___- �..-.
TO THE FUSL.,(C 5^EWER. APPROVALS DATE INS,INSPECTOR'S SIGNATURE
SIGNED TFiIS_---GRAY OF__.._
OWNER OR NEW.HOUSE SEWER
._ _-_ ._ __--_—
OWNERS Aii ENY ---- CONNECT ADDITIONAL F
BUILOI NG OR WORK �
ADDF2 S�-r
..- SEPTIC TANK,SCEP.PITIS) I
I h F4rnt' ACKNOWLEDGE t'HAT 'I SHAVE: READ 'rHIS- APPLICATION AND/OR DRAINE"IE.LD
A:�.!: S A E'. THAI 1HE A60VE IS CORRECT AND AGREE: TO COMPLY
WITH ALL COU Nr ORO NANCES AND STATE LAWS REGULATING !
PLUM@LNO AND SEWERS. CESSPOOL ❑ OPYWELL ❑
1 HEREBY- CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LI CENSEO AS RE'l 1 3 L.OS ANGLES COUNTY AND STATE OF SEWAGE E DISPO AL SYSTEM 1
C
ALIFORNIA OR THA. A T'kkE ECA �9R OF, ND INTEND TO I ---"- --- — -" "---"---- -"
RE51DE IN, THE A.6 E DF.S'::RI B'cU RE.S':C NT O ET TY. DSSG-ON NEGT PLUG AND
ABANDON HOUSE SEWER
SIGNATUREBACKFI[1 SEPTIC 7 hK ❑ — - -- -- -
OF PERMITTEE -� ✓ d.. _ T-y...-6c _.- SEEP,P1,iS) ❑. CESSPOOLS ❑..
,- VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL, ENGINEER
CK. W 0. CASH