HomeMy Public PortalAbout9553-9557 LONGDEN AVE_Sewer__ APPLICATION BION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engiww
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County of Los Angeles AD8UD1LDINO
WM.J. FOX, COUNTY ENGINEER
CASSATC 0.GRIFFIN,SUPT OP 8111LOINO LOCALITY 77e .0
FOR APPLICANT TO FILL IN CNEARER6SSST
RO55 ST, ����_�
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DESCRIPTION _LOT NO. °�:..: _ OWNER
;:LOCK - TRACT 1. �' MAIL
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m No. OF BLDCS, .
S1.ZE OF Lq7 _-- NOW ON LOT .� CITY ""'; TEL. hO.
USE OF
B.U?LDLNGS—yvcr` =_ � _ DISTRICT N0. GROUP ! MAP
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ADDRESS CONNECTION DATA
CITY _ .3' '��" .' TEL. NO. e+� ..' i'�„ . STATION_ DEPTH
a ;i DEPTH
L STATE MANHOLE REFERENCE
NO.
REGISTRATION
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NO. DESCRIPTION OF WORK FEE -----------
TYPE
---TYPE OF CONNFCTION LENGTH FROM
HOUSE SEWEIR CONNECTING TO s v L. PL '� �•�
_
PUBLIC SEWER_ �' � 3 CURS P C9 0� s --�-- -- M.L. TO TO
F CUSS SEWER CONNECTING TO — l
- {
Ps,IVATE DISPOSAL SYSTEM__ i.OD� ---- - -----_------------------__ _-_.
�1 CONNECT ADDITIONAL BLDG.OR � — — J R C NO
aORK TO HOUSE SrWF'13:_ 1 00 _ �"7 IMP NO._-�` 1.�,� Jr7S !O. -
--i ALTT-R�OR REPAIR EXitmNC,
_ ! SEXtR ORDISPOSAL SYST_E PS _ 1.6_0 � TRUNK PERMIT N`1, ROAD PERMIT NO;
D CONNECT AND ABANDON SEWER --- -- ---- r-Y'--�--'�—
---I AND/OR DISPOSAL SYSTEM i._9_.0_0 .TATE ENCROACHMENT'-� PERM T NO _
i SEPTIC TANK, SFEPACE PIT OR I --__
PITS AND/OR DPAINFiELD 2,00 l INDUS TIAL
'.� - --'---- -
CESSPOOL DWASTE APPROVAL
I?'f4v£LL -
____STFCIAL CO YDITIORS.ONLY 2 OU CHARGES
` CONNEC ON CHARGE FEE
OWNER'S PERMIT
AUTHORIZATION DOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED ITF1 T7E HEREIN NAArD CON-
TRACTOR
ON-T:A. OR TO CONNECT THE ABOVE DESCRIBED EXISFINGWNELLING APPROVALS DATE -�INSPECTOR'S SIGNATURE
�
TO THE PUBLIC 3FltiEFt - --g— - -
" NEW HOUSE SEWER
SLG ETD THIS s ? )AY OF
0'"d NFR OR CONNECT ADDITIONAL # _� W� ✓~�
O N PS AGENT_ h'° BUILDING OR WORK_
__._- ° "`° + ._ f ° ^� SEPTIC TANK, EFS', FIT(S)
U_R
ADCSS._..e, PND/OR DRAINF ELD 1!
I HhREPY ACKNOWLEDGE THAT 1 HAVC 'READ THIS APPLICATION. CESSPOOL tj DRYWELL.0
AND STATE THAT HE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES A14D STATE LAWS REGULATING ALTER, REPACK SEWER OR
PLUMBING 4^7D SEWERS. SEWAGE DISPOS F SYSTEM?
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -- ---- -" --
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STALE. OF DISCONNECT PLIC AND
CALIFORNIA OR THAT I ASA THE LEGAL OWNER OF THE ABOVE ABANDq^d HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. ------_a_
BACKFILL SEPTIC TANKS(c`.
SIGNATURE '} SEEP. PITTS). ElCESSPOOLS 0_ r
:t° s .--tl,- _�,_..t._.,.�
OF PERfivIITTEE
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WILLIAM J.FOX. COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLEG. INSPECTOR
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