HomeMy Public PortalAbout9554 LONGDEN AVE_Sewer__ nEr�x rr OF COUNW ENGnvEERER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING-AND SAFETY` PERMIT APPLICATION
COUNTY OF LOS ANGIELES _
WILLIAM J:7Pl3X_V-CCUENGINEER ADDRESS
ENGINEEBUILDING
ADDRESS �� J � �'4e4.,�Z�i�-•jws �'�"l
��FyyOR .APPLICANT TO FILL IN LOCALITYBUILDIN
ADDRESS NEAREST
- _ ► "Y'�-t7--:'->'� i��-� CROSS S.T..
LOCALITY ? f.' DISTRICT NO. SERIAL NO- PERMIT NO.
NEAREST I f /r �� A. � .•J /,5-6-57
�6� S'
CROSS ST. �'J R�CEVED BY Readylor Inepectlon DATE ISSUED
r
OWNER C_'' � /' '� J
s .t if:!' �` € �I � •-F� s
MAIL j I USE ZONE OCCUPANCY MAP
ADDRESS _-. BK PG
•-V w�" v q
CITY TELAO. L1 a
CONTRACTOR� i •'` ry �R f �' ..�.�'•.- .�'. . /•i"./1e�.,...-.rd'".., CO.IMP.No.
ADDRESS f ,,
JOB.N0. .� 6
CITY Fq,C.1it f TELAO. &° V' 9411 TRUNKPERMIT.NO.
REGISTRATION NO ®rCOUNTY
ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK. TRACT INDUSTRIAL
WASTE APPROVAL
8
NO.OF BLOGS.
SIZE OF LOT
NOW ON LOT CHARGES
USE OF
BUILDINGS- ~ _. � CONNECTION CHARGE
FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER a $ 3.50 RECEIPT NO. I _-D)TE• I BY
HOUSE SEWER CONNECTING TO .�
PRIVATE DISPO$Ak SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR c B EXCEPTIovf RE06RDED
WORK.TO HOUSE SEWER - 1.00 •'-
ALTER OR REPAIR EXISTING NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00-
DISCONNECT AND ABANDON SEWER
- AND/OR DISPOSAL SYSTEM 1.00. - — -— •CONNECTION.DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION X DEPTH
CESSPOOL--DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE _
UPPER LOWER
I TYPEOFCONNECTION LENGTH FROM
OWNERS PERMIT .$ a00` Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE D-b -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED.
CONTRACTOR TO CONNECT THE ABOVE DESCRI'8ED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS... ...D.Y Q ._ _ ,)g NEW HOUSE SEWER •�fl■
OWNER OR " "G�• " CONNECT ADDITIONAL
OWNERS AGEN yT" �R -s....__
BUILDING OR WORK
s�J' t� . SEPTIC.TAN.K,SEEP.PIT(S)
ADDRESS...
�: ...,,• 3R.. ..... .._...:....�... ; AND/OR DRAINFIELD
i HEREBY ACKNOWLEDGE THA191'HAVE READ THIS APPLI• CESSPOOL r DRY
'CATION AND STATE THAT THE ABOVE 13 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSALSYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
DISCON
AND/OR LICENSED AS REQUIRED BY L-08 ANGELES COUNTY DISCON N-HOUSESEWER
AND STATE OF CALIFORNIA OR THAT 1 'AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBEq//PUIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S) CESSPOOLS
SIGNATURE t"
OF PERMITTEE.`!srri�=yet,{ :. :.,.. :i _`..... ,
-76A642D 663 1/53 ,�/ . APP"