HomeMy Public PortalAbout9601-9603 LONGDEN AVE_Sewer__ 76A642D
CE BOBIREV.61781
�s APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT N0. GROUP MAP PR SSED BY
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ADDRESS - -
LOCALITY �� ,- �d �`.1f CONNECTION DAT
NEAREST / STATION - -- DEPTH
CROSS ST. x"'(r, , .
UPPER
MANHOLE REFERENCE LOWER
OWNER , f '.�'/,� TYPE OF CONNECTION LENGTH FROM
MAIL �(,� �°° Y. CURB P.L. M.L.TO P.L.
ADDRESS �.+>'� / - 'YL G� I,17.r' E_..
P.C.NO.
NO.f TE
CITY e, ��i/� L. CO.IMP.NO. JOB NO.
1
LEGAL y .yam J TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO. ! �C,e+'S� ' j �r
AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT
NO.OF B DGS.
SIZE OF LOT NOW ON LOT rt HWY.OR ST.WIDENING
USE OF ,P �,
BUILDINGS -.�"yL• �: j STATEENCROACHMENT
PERMIT NO.
�� - - y` INDUSTRIAL
CONTRACTOR
WASTE APPROVAL
ADDRESS f' s�' -vfl l6gzle— CHARGES
CITY d TEL.NO. ' /� -��-- CONNECTION CHARGE FEE
STATE LIC. REIMBURSEMENT FEE
LICENSE NO. CLASS O
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE V
HOUSE SEWER CONNECTING TO /
?� PUBLIC SEWER / 1,
NEW HOUSE SEWER
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL W
HOUSE SEWER CONNECTING TO BUILDING OR WORK iWWWY
PRIVATE DISPOSAL SYSTEM 4
SEPTIC TANK,SEEP,PIT(S)
CONNECT ADDITIONAL BLDG.OR v✓f
AND/OR DRAINFIELD
WORK TO HOUSE SEWER Z
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DRYWELL❑
EXTN.,CESSPOOL,DRYWELL.MANHOLE
ALTER,REPAIR OR ABANDON HOUSE ALTER,REPAIR,SEWER OR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
SEEP,PIT(S)ElCESSPOOLS J
OWNER'S Permit s
AUTHORIZATION I TOTAL FEE VALIDATION j 7
I HAVE AT THIS DATE AONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THCE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_
OWNER OR
OWNERS AGENT
ADDRESS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RE-
SIDE IN.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE
OF PERMITTEE
76A642D
CE 808(REV.6/781
PJ s APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICTNO.
GROUP MAP ROC'S RY
ADDRESS !) i,''' '� �� ...� J c J,P
LOCALITY �>``" a CONNECTION DAT ``
NEAREST . STATION '1 — DEPTH
CROSS ST. � /y ad -
UPPER
MANHOLE REFERENCE LOWER
OWNER '' ' .
TYPE OF CONNECTION LENGTH FROM
MAIL CURB/ M.L.TO P.L.
ADDRESS may,ey „t',. -�./-�/dr '' y, e/✓ V P.L.
P.C.NO.
GITVd TEL.NO. �/ ' '�-:. CO.IMP.NO. JOB NO.
LEGAL a TRUNK PERMIT NO, ROAD PERMIT NO.
DESCRIPTION LOT NO. / j' ,
AFFIDAVIT I WAIVER I EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT �y-
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT +' HWY.OR ST.WIDENING
USE DI LDINGS
BUI _/ J STATE ENCROACHMENT
" a
PERMIT NO.
CONTRACTOR INDUSTRIAL
+�'�C`a(:✓ Ike'-�P - !',.a �J`s'�. WASTE APPROVAL
ADDRESS ` /
CHARGES
CITY TEL.NO. CONNECTION CHARGE FEE
STATE LIC. ..7, REIMBURSEMENT FEE
LICENSE NO. CLASS
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTORS SIGN TYRE (�
HOUSE SEWER CONNECTING TO )
PUBLICSEWER
SEPTIC TANK,SEEPAGE PIT OR -NEW HOUSE SEWER 3
ITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM d
CONNECT ADDITIONAL BLDG.OR SEPTIC TANK,SEEP,PITIS)
AND/OR DRAINFIELD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL Cl DRYWELL[IE XTN.,CESSPOOL,DRYWELL,MANHOLE
ALTER,REPAIR OR ABANDON HOUSE ALTER,REPAIR.SEWER OR
SEWER OR D SPOSALSYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS❑
OWNERS Permit S -7 �� SEEP,PIT(S)El CESSPOOLS❑
AUTHORIZATION TOTAL FEE ,/ - /// /y V�A�LJIIDATIO)N ' ]
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- 'C"! W / ! �,�
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_
OWNER OR
OWNERS AGENT
ADDRESS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RE-
SIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE
OF PERMITfEF�. ...