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Home My Public Portal About9523 LONGDEN AVE_Sewer__ Esoo 6.50 APPLICATION FOR PE.RIVII f `✓ COUNTY OF LOS ANGELES SEWER—SEWAGE DISPtItAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS x CASSATT D. GRIFFIN, $up t of Building LOCALITY NEAREST --- FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. '' "}y -�a ,{;3 OWNER �-— MAIL BLOCK TRACT ADDRdS55 — -- - - NO.OF BLDGS, (- SITE OF LOT NOW ON LOT CITY -'",_r'r+ " L. NO. - USE OFI DISTRICT NO. GROUP MAP PROESS BY BUILDINGS BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY "-, CEL.N0. STATION[} ��•- �`,. DEPTH REGISTRATION NO, COUNTY REFERENCE U NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER C $3.00 ` TYPE OF-CONNEft4ON LENGTH FROM / V SEPTIC TANK,SEEAAGE PIT OR CURB i' P.L. M.L.TO P.L, .y'. PITS AND/OR DRAINFIELD $3.00 A� _ ' .. OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL $2,00 i 14011SE SEWER CONNECTING TO � ; �I P,C.NO, PRIVATE DISPOSAL SYSTEM $1.00 Co.IMP,N0. ¢ JOB NO. CONNECT ADDITIONAL BLDG,OR WORK TO HOUSE SEWER $1.00 TRUNK PERMIT N0. ROAD PERMIT NO, CK+ ALTER,'. '"-HOUSE STATE ENCROACHMENT SEWER' $1.00 � '� _PERMIT NQ, INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s 2 OO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 1 3 REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR T'0 CONNECT THE ABOVE DESCRIBED EXISTING .DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS—DAY OF_— 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT____ EU?L DING OR WORK ADDRESS._ `EPTIC TANK,SEEP.PITS) -- -- --- AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION '— AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL, 0 DRYWELL ("_1 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGALTER P it-� : 1eERGi- — PLUMBING AND SEWERS. SEWfi.G.E DIS.^�35�'iL SY R CIR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWA DIS PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OW14ER OF THE ABQVE — DESCRIBED RESIDENTIAL PROPERTY, d BACK.FiLL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT(S) ['j CESSPOOLS El OF PERMITTEE ti a„ �e z VALIDATION ROBERT A. WOOD c... U.o. CASH SUPERVISING MECHANICAL ENGINEER 76$642° APPLICATION FOR PERMIT 1 cseoae-sa COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _ JOHN A. LAMBIE, County Engineer ADDRESS i CASSATT D. GRIFFIN. Sug't of Building LOCALITY w NEAREST FOR APPLICANT_ TO FILL IN cRQss Sr FIPTION ° LOT H0, ro OWNER r '� , ✓ ' r=-'. TRACTMAILNO,OF BLDGS.NOW ON LOT - CTTY d- TEL.N0. ( X i _{ - D15TR1CT H0. GROUP 'r EK MAP PG PROCESSED BY CONNECTION"DATA CITY ![.6Y_ - STATION DEPTH y >� �° ❑ STATE MANHOLE RtFERENCE UPPEkt REGISTRATION NO;' 5 av ❑ COUNTY ' No. E�cr�rprrorr o� wox EE _s LOWER HOUSE SEWER CONNECTING TO PUBLIC'"SEWER __ @ $5.00 SEPTIC TANK,SEEPAGE PIT OR TYPE OF CO"—ECTION LENGTH FROM PITS AND/OR DRAINFIELD 0. $3.00 _Y. CURB, P.L. MR L.TO P.L. OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN-CESSPOOL,DRYWELL,MANHOLE.@_$2,00 ' HOUSE SEWER CONNECTING TO P,C.NO. PRIVATE DISPOSAL SYSTEM rQ $1.00 CO.IMP. NO. JOB N0. CONNECT.�,�((D1710 AL.BLDG.OR TRUIIK PERMIT N0. ROAD PERMIT NO. WORT{TO kl4USE.€,WER _ @ $1:OU _ +, ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT � SEWER OR DISPOSAL SYSTEM SiL�00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES � .9 OWNERS PERMIT 1 2 00 CONNECTION CHARGE FEE AUTHOMATION I TOTAL FEE 3 -�, REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS BATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEINER. - SIGNER T'HM �-'fi DAY OFNEW HOUSE SEWER OWNER OR ` -�'✓- CONNECT ADDITIONAL OWNERS AGENT _ BUILDING OR WORD _ SEPTIC TANK,SEEP,PIT(S) ADDRESS !"_ _ _AND/OR DRAINFIELD _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL[I DRYWELLQ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGA�"WNER OF TPE ABOVE - -- DESCRIBED REST DE TI& PROPE,tI�SY /�' 1 BACKFILL,SEPTIC TANKS C3JJJt SEEP.PIT( S) SIGNATURE C1 CESSPOOL S OF PERMITTEE �Ir VAY.IDAT ION ROBERT"A.WOOD M.n. CASH SUPERVISING MECHANICAL,ENGINEER i § y L4 r .' d