HomeMy Public PortalAbout9531 LONGDEN AVE_Sewer__ CE8##,10-62
ieA'e#2b APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION
JOHN A. LAMSIE County Engineer _J
ng
WILLIAM A. JENSEk Supt of Buildiz
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
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ADDRESS
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NO. OF SLOGS. ✓
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SIZE Or Lc�, NO ON LOT TEL.
USE OF DISTRICT N11]GROUP
BUILDINGS MAP Ocissizci By
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ND ------------
..._r�� DES RlPili"ON 0 'WORK FEE TYPE OF CO-Wf4FCT)6N LENGTH FRv"t_—.
CJ EWER.CONNECTING TO Y, P.L. M.L.TO P_L�
P
SEWER S @ $5.00 0
P.C.NO,
SE
PITS AND/OR DRAIN-IELD @ $1 000 CO.;MP NO. JOB NO.
�_HOU_SE SEWER—CO-_
14NECTI NO TO0
TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADD TONAL ---RECORD, 114s—TR7
DATE
WORK TO HOUSE SEWER $3.00 Lu
OVERFLOW SEEPAGE PIT.DRAIN FIELD
.--_�yTER.7N-,CF�iSPOOL,DRYWFL.L,MANF40LE@ $5.00 HVYY. OR ST.WIDENING z
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SEWER OR DISPOSAL SY57FM @ $3.,
STATE.ENCROACHMENT
_PERMIT NO-
CINDUS:iRTAL
WASTE APPROVAL
CHARGE
S
OWNI PERMIT $ 2 co
i CONNECTION CHARGE cFE
AUTHORIZATION I-To-T__A L—FEE--'---- __ I
I , SUR
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIM. SEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXITING DWELLING
---
C:
p I I DATE�,�SPE
THV U b IC SEWF,,.R. APPROVALS CTOR'S SIGNATLARE
SIGNED THIS.___—r OF.
OWNEIR OREW HOUSE SEWER
Ov'iNEF15 AGENT
CO N N ECT ADDITION A L
BUILDING OR WORK
THAT I HAVE RCA D T F11 6 ANO,'OR aRAINF[ELD
STATE THAT THE A BOVE [5 E
14 - _ SFPTIC TANK,5PEP,F�T(5)
ADDRESS-- , �
IHEREBY ACKNOWLEDGE
AND CORRECT AN A G Rt TO COMPJ.Y
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU MB ING A44D SEWERS. CESSPOOL [] D.RfWELL
LIJEHERESY CERTIFY THAT A.W. PPOPFR'"Y REGISTERED AND/OR ALTER,_RiPA_1R,SEWER OR -------
10
C NSED AS REQUIRED 8Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTE14
AL FORN A OR THAT I A-�. 111 7 AL OW N E R OF, AND INTEND TO 5170
I I IEG
5 L! NNECT PLUG AND
BAND ON HOUSE SEWER
RESIDE IN, THE ABOVE OF CRiiYFO RrSIDENTIAL PROPERTY. A
SIGNATURE
BACKFILL SEPTIC TANKS o
1 ..P,,."s CESSPOOL6 F
OF PERMITTEE /�,_,4�
VALIDATION" ROBERT A. WOOD
CK. M.0. CASH N SUPERVISING NIECHANICAL ENGINEER