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HomeMy Public PortalAbout9543 LONGDEN AVE_Sewer__ .Ecib83..62 APPLICATION FOR PERMIT '� - COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BU I L D I N JOHN A. LAMBIE, County Engineer ADDRESS Ck WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST s FOR APPLICANT TO FILL IN GROSS-ST LEGAL f r DE"CR PTION, _I."-.N] 04v I•!ER MAIL "-t..-_-. S,�—• �--____ BLOCK TRACT 5�5 �� !fM',: ADDRESS NO. OF BLD S. 5 1E OF F NOW ON LOT J' CITY TEL. Pill. U5E OF H`ILDINGS S -+ DISTRICT NO. GRO..P MAP `'' PROCESSED BY ' _t CONTRACTOR -w- --- - ADDRESs z t _ _ , »--_--- CONNECTION DATA - - - STATION ,rt - DEPTH CITY� E L.. STATE LO MAN REGISTRATION NO COUNTY MANHOLE REFERENCE LOW, R NC_ DESCRIPTION (7 f� 'WORK FEE _ 7YF E OF CONI'ECTION l� TH FRP'M J- HOUSE SEWER CONNECTING TO ;r�T +; Y CURB r P L M.L TO P Ly' 1p$�. PUBLIC SEWER _L - �/ J.__♦-_ ___ -_.-. _____ �. _-.- _ P C NO F� SEPTIC TANK SEEPAGE PIT OR ! s / Y PITS AND/OR DRAINF ELD - C+� $10.00 Co. IMP 1.40, -__-_- r--� _ .- _._-- YOUSESEWER CONNECTING 70 TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM $3.00 � I __-_-__ _.. ]WAIVER r..-.-._._.-_ _-_ __-._ —_ T+-ONhECT 9UDIT!ONAL BLDG-OR I F AFFIDAVIT I WAIVER! EA EMENf RECORD, IN=TR NO �- DATE WORK TO HOUSE SEWER @ $3.00 -.- A ---- OVERFLp�J 5F PAGE PIT 4RAIN FI LD A- LX . W _L, AO@5.00T� ' HWY. OR ST.WIDENING A TERr REPA w OR_ABANDO_ NOUS£ _ - - SEW ER OR DISPOSAL SYSTEM-- @--33.00 I - _-_.-.- ---__ _ ___ _ —.-._ --_.-- _ -___.._.. STATE ENCROACHMENT INDUSTRIAU WASTE APPROVAL _. CHARGES _-_R-VVNER�R PEMIT - $ - - 2'' 00 O ----- - - - ------ ------- -- - AUTHORIZATION[ TOTAL FEE C<`NNG T!ON CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. RFIMBUR_EME.NT FEE TRACTOR Tp CO INECT THE. ABOVE DESCRIBED EXISTING DWELLING ------ /'y�}-- _- - - -- - - --� ---------- TO THE PUBLIC .-SEWER. APPROVALS ALS? DATF INSPECTORS SIGNATURE SICNE.D THIS.----- ' .. .._ DAY Or4NEFC� UWNLRSAGTI -NEW HOUSE SEWER___ ——D-N--T-----WORK R KCONED -A-{.__-_.__—. BUI SEF'TlG TANK,SEEP,PI'T(5) i H RF,BY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AN'D/<)R DRAINFIELD .AND TATE THAT THE AC+.OVE IS CORRECT AND AGREE TO COMPLY W,rH A.L_ CGUN'T�' ORDINANCES AND STATE LAWS REGULATING PLUM©ING AND SEWERS. CESSPOOL. ❑ DRYWELL I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR � LICENSED AS REQUIRED. BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM GALIFOAN LA. OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO _.._-_- _ ____.____f_-___- -._-- DI5`.'ONNECT PLUG AND RSSID£ iN, THE AB VE,�D. C:R!BE,.p FF,"SIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE k a,,, BA':,,.K,Fi Li SEPTIC TANKS OF PERMITTEE✓_ '-�' I"'' I . '. .t_ - _ . Pf�($1 [� CESSPOOLS QI VALIDATION ROBERT A. WOOD CK. O. CASH SUPERVISING MECHANICAL ENGINEER M. VA PLE lurrY 8A6421) E808 8-59 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER '1'7 "'L BUILDING AND SAFETY DIVISION A D D RTS SIG JOHN A. LAMBIE, County Enaineer CAMTr D. GRIFFIN, Supt of SuilLd2ing LOCALITY NEAREST _v FOR APPLICANT TO FILL IN CzOSS ST. LEGAL DESCRIPTION LOT NO. OWNER 4" c.v­ BLOCK TRACT "t'L ADDRESS Z'? F NO.OF BLDGS, SIZE OF LOT K ':4 NOW ON LOT CITY TEL, NO. USE OF _LUILDINGS DISTRICT NO, GROUP MAP PROCESSED BY BK PG CONTRACTOR v, a ADDRESS CONNECTION DATA CITY TEL.NO. STATION DEPTH ❑_REGISTRATION NO. ❑ STATE MANHOLE REFERENCE UPPER COUNTY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER - @ $3.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB PITS'AND/OR DRAINFIELD @ $3.00 P.L. M,L�TO P.L. OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN,. CESSPOOL,DRYWFLL @ $2.00 HOUSE SEWER CONNECTING TO P,C.NO. PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. NO, JOB NO.' CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. ABANDON HOUSE STATE ENCROACHMENT A;=`Dhl=plllL SYSTEM @ $4.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE I!NSPFCTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THISDAY OF 19- NEW HOUSE SEWER OWNER OR OWNERS AGENT CONNECT ADDITIONAL - BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I A14 PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESID,*"AL PROPERTY, BACKFILL SEPTIC TANKS n S 'NA SEEP.PIT(S) [] CESSPOOLS !OrF FTE"IRMETTEE VALIDATION-__ ROBERT A. WOOD CL U.0. 7CASH SUPERVISING MECHANICAL ENGINEER L"o 2 !5 3, 5. Ofq UZI, ' s80aoa e•a4 APPLICATION FOR PERMIT e t;, COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, County Engineer CASSAIT D. GRIFFIN, Sup t of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. TL l�Z. C',ti-, 1 LEGALa'ryfic,-1 X33= t +­1'ai 'i}Iry DESCRIPTION LOT NO, ffi g sir S OWNER +t{ISL- Y it-—.c BLOCK TRACTMAIL L-,V.A 'rfv.. ADDRESS , Z" NO.OF BLDGS. SIZE OF Lor V�/ Now ON LOT CITY "7'c.ws c ,"� TEL. N0. +`- USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY BK PG I CONTRACTOR ADDRESS 1-3 '✓ CONNECTION DATA CITY '"Tvtro�yyt�� y - TEL,N0. }y -Fb STATION DEPTH Q STATE MANHOLE REFERENCE UPPER PEGISTP,ATION NO. ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER C� $9.00 TYPE OF CONNECTION, LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/ORDRAINFIELD @ $9.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN.,CESSPOOL, DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.N0. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. .JOB NO. CONNECT ADDITIONAL BLDG,OR ORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT TIO, W _ RLT.ER,REPAIR ORtI SY DON HOUSE � " STATE ENCROACHMENT - EWER OR IS, - @ $1:00 PERMIT N0. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 1 21 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I = REIMBURSEMENT FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NCON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDP:ESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL 0 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR 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 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEM PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE a SEEP.PIT(5) ❑ CESSPOOLS OF PERMIT EE ° �P s" .VALIDATION ROBERT A. WOOD { X.0 CA$0 SUPERVISING MECIiANICAI.ENGINEER i