HomeMy Public PortalAbout9537 LONGDEN AVE_Sewer__ E
ISa E-663 3.55 APPLICATION FOR PERMIT
DIVISION
& -66
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Loa Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRE55 vby !_ __
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY' s
NEA
FOR APPLIC T TO FILL IIS'
REST
caoss ST. ?� =
LEGAL "
DESCRIPTION LOT NO OWNER '
BLOCK
TRACT,/ MAIL
ra —
ADDRESSV- NO. OF BLDGS, +y 3 a
_SIZE OFLOT _ sy,;y NOW ON LOT CITY .�'-.- ,t #• ,F`,.'�.,;.` E[.. NO. '
USE OF
BUILDINGS_ _ DISTRICT NO. GROUP MAP
BK PG
'CONTRACTOR ''r r�
ADDRESS - - ,:; ✓ CONNECTION DATA
v
_CITY EL. ND.A, ' -STATION -- .. DEPTH
_„�i �e ATE MANHOLE REF RENC, M_FR
REGISTRA N 1(0_` �=--� • ❑ COUNTY --- ..-_____._ .--.---- ------ _ J-rLOWER
NO. DESCRIPTION OF WORK FEE
TYPE C7 a .'ECT Ort LENGTH FROM
HnWE SEWER CONNECTING TO - Y. CUdB L. M L 0 P L,
PUBLIC SF
,,,ee��••��
- - ER ----_._..6L $ 3.50..
HOUSE SEWER CONNECTING TO
PRIV^TED 5POSAL SYSTEM 1001.
CONNECT ADDITIONAL BLDG. OR -j^� P C N0.
WORE TO HOUSE SEWER_— 1 00 1I _ CO. IMP NO. JOB NO.
ALTER OR REPAIR EXISTING
TRUNK PERMIT NO, ROAD PERMIT NO.
! SEWER OR DISPOSAL SYSTEM _ 1.00i _
� DISCONNECT AND ABANDON SEV.'ER STATE EPICROACHT.ETN-C---`A- --- "
_ ANulOR DIS90�AL SYS7FA°_ _1_.00 PERMIT NO.
SEPTIC TANK SEEPAGE PIT OR
_PITS AND/OR DRAINNELD„ .00( INDUSTRIAL �I
cF55PO61 DRYLwcLL
WASTE APPROVAL
SPLtiIAL
CONDITIONSONLY 2.00 — CHARGES
— --
CONNECTION CHARGE FEE
PERMIT F I 00
AUTHORIZATION TOTAL FEE --� - } — REHMIBt RSEMENT FEE.
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- �� "�`•
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE� - - -'-'_'-'-'-- - -- - - -
SIGNED THIS_.. DAY OF NEW HOUSESEWER -- -- -� -
9
OWNER CAt
CONNECT kDDiT10AL �` -
OWNERS AGENT " I/Zf -��'' - - BUILDING OR WCRK_^ -_—_
SEPTIC TANY., SEEP, PIT($)
`_ - _ AND/0-R DRAINFIELD
-f HEREBY ACKNOWLEDGE THAT 1 HAV READ THIS APPLICATION --CESSPOOL❑ DRY'WELL
AP{0 STATE THAT 3"Mc ABOVE 1S CORRE ANFS AGREE TO COMPLY _
WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SE4VFR OR .—�
PLUMBING AND SEWERS.. SEWAGE DISPOSAL SYSTEM
I HEREBY' CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -"� ""__ . - I
LICENSED AS REQUIRED BY LOS ANGELES COUNLY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA 0 THAT I AM THEjLEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWEIR
ESCRIBED RE DENTVIr PROPER
BACKFILL SEPTIC TANKS L�
� , SEEP. Pi;(S) CESSPOOLS ^ i ?
OF PPE�RMI >i -r i
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF FLBG, INSPECTOR