HomeMy Public PortalAbout9547 LONGDEN AVE_Sewer__ i
6A8420 APPLICATION FOR PERMIT`
>eos a-se COUNTY OF LOS ANGELES SEWER—SEWAGE DIS�bSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING j a --
ADDRESS Cdr
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL -
DESCRIPTION LOT NO. se+ a �+' tt /S OWNER
BLOCK TRACT — MAIL
r'9:: _ADDRESS
NO.OF S
SIZE OF LOT--' ".--Y
1- NOW ON LOTCITY s L d Ly r. TEL. NO.
USE
BUILDDINGS `F�.,:. DISTRICT N0. GROUP' MAP PROCESSED BY
-
!! * sP BK PG -
CONTRACTtTTt' / 'l ri 3
ADDRESS - CONNECTION DATA _
CITY TEL.NO. ` ' �` STATIONDEPTH
;j STATE MANHOLE REFERENCE {
REGISTRATION N0. ✓` " -� ,�'r.-
NO. DESCRIPTION OF WORK FEE
�y HOUSE SEWER CONNECTING TO _
PUBLIC SEWER @ $3.00 t:".>
TYPE O"IjNNES;TION LENGTH FRO14
SEPTIC TANK,SEEPAGE PIT OR Y. r CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN,,CESSPOOL. DRYWELL @ 52.00
HOUSE SEWER CONNECTING TOC.NO.
PRIVATE DISPOSAL SYSTEM. @ $1.00 CO. IMP.NO. :?; 17
- JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. r .
WORK TO HOUSE SEWER @ $1.00 - --�
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISP05AL SYSTEM C� $1.00 PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVMER'S PERMIT g 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE_ Lc° -C _REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- —
TRACTOR TO CONNECT THE ABOVE DESCRIB U EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLICSEW �/ - a —
SIGNED ZNI3 DA OF 19 NEW HOUSE SEWER
OWNER p f r CONNECT ADDITIONAL
OWNERS AGE T BUILDING OR WORK
` SEPTIC TANK,SEEP.PIT(S)
ADDRESS - _ AND/OR DRAINFIELD
I HEREBY ' KNOWLEDGE THAT I "HAVE. READ j7HIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY rESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,1LTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY GIS'-ER -AND/OR DISCONNECT PLUG AND
LICEN.$L-9""7L�a R ED BY LOS -G C NTY STATE OF _ARANDONHOUSESEWER
CALIFORNIA OR THA I A14,.7, L NER THE ABOVE
DESCRIBED RESIDENTIA P _E Y BACKFILL SEPTIC TANKS ❑
SEEP.PIT(S) ❑ CESSPOOLS ❑
SIGNATURE.
OF PERMITTEE-
�� VALIDATION ROBERT A. WOOD
CK. Y.O. CASH SUPERVISING MECHANICAL, ENGINEER