HomeMy Public PortalAbout9609-9611 LONGDEN AVE_Sewer__ 76A642D
t5 8081RE".6/78) APPLICATION FOR PERMIT
9'�
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP MAP ROCS E BY
sr� y 8K PG
BUILDING
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ADDRESS eL Qr �.- �p�.�f+� /
9p CONNECTION DATA
LOCALITY
NEAREST .� _r� STATION .4. 1 <- DEPTH
CROSS ST. O r -may
- UPPER
y MANHOLE REFERENCE
OWNER 1 ,� - �v'-Sd`-•,9�,i LOWER
TYPE OF CONNECTION LENGTH FROM
MAIL
ADDRESS .L) Y. CURB P.L. M.L.TO P.L.
`Y CO.IMP.NO. JOB NO.
CITY -' TEL.NO.
LEGAL TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO.
AFFIDAVIT I WAIVER I EASEMENT RECORD.INSTR.NO. DATE
BLOCK + TRACT `- •
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT j HWY.OR ST.WIDENING
U SE OF r. ��>�
BUILDINGS f.,� - L ✓ STATE ENCROACHMENT
7 PERMIT NO.
CONTRACTOR !4-y fr'- � �,✓ INDUSTRIAL
WASTE APPROVAL
ADDRESS _ C� CHARGES
CITY TELNO. CONNECTION CHARGE FEE
.
STATE LIG. �-
LICENSE NO. CLASS REIMBURSEMENT FEE
._��"
NO. DESCRIPTION OF WORK FEEAPPROVALS DATE INSPECTOR'S NA
SIGTURE u
HOUSE SEWER CONNECTING TO
PUBLIC SEWER f 40' � S
SEPTIC TANK,SEEPAGE PIT OR
NEW HOUSE SEWER
PITS AND%OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM TANK.SEEP.PITS)
CONNECT ADDITIONAL BLDG,OR AND SEPTIC IC DRAINFIELD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DRY WELL El
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
BAG KFILL SEPTIC TANKS❑
SEEP.PITIS)E3 CESSPOOLS El
OWNER'S Permit s
VA
AUTHORIZATION TOTAL FEE LI�A�I N.7 S —7.�
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR
ON 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 15 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 PERMITTEE
J6A642D
-E8081REV.6/79i
Js APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
lb
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. I GROUP I
5 J ' 1BKPG MAP PROC Ss D BY
BUILDING
,�} r+�/ yn3 'Sfid'J / �' 7�//
/ .,/ - 1
CONNECTION DATA/
LOCALITY .. f_
NEAREST _ _ rr STATION ^"S - DEPTH
GROSS ST. 1" d>" ^`-3 ,. �✓.' s�.�- ,.
UPPER
,.,�+ MANHOLE REFERENCE LOWER
OWNER f, /Y TYPE OF CONNECTION LENGTH FROM
MAIL Y. CURB P.L. M.L.TO P.L.
ADDRESS �
P.C.NO.
u'
CITY TEL.ff. � CO.IMP.NO. JOB NO.
rT 6. �' 7 ,' UG
LEGALTRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO.
_ AFFIDAVIT WAIVER I EASEMENT RECORD.INSTR,NO. DATE
BLOCK TRACT ._-j "-,r`j t.".-6..
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF
BUILDINGS '__�!/`/�a y+ STATE ENCROACHMENT
-'y PERMIT NO.
CONTRACTOR Y'L�-L% f &.y: / - I INDUSTRIAL
WASTE APPROVAL
ADDRESS
CHARGES
CITY TEL.NO. CONNECTION CHARGE FEE
STATE LIG. ;' REIMBURSEMENT FEE
LICENSE NO.. CLASS rU 0
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE v
j HOUSE SEWER CONNECTING TO 7. Cie
.j PUBLIC SEWER }. Y;I O
SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWER 5 ,_*a
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL Y
HOUSE SEWER CONNECTING TO BUILDING OR WORK {{{{YYYY
PRIVATE DISPOSAL SYSTEM d'
SEPTIC TANK,SEEP,PIT(5)
CONNECT ADDITIONAL BLDG.OR '
AND/OR DRAINFIELD
WORK TO HOUSE SEWER f—.
OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL 71 DRY WELL❑
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,PITISI��,.,• CESSPOOLS❑
OWNER'S Permit s VALIDATION
AUTHORIZATION I TOTAL FEE cti 9 S o 1
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- 2t'tt_-''.cL_'
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TOTHE 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.
I HEREBY CERTIFY THAT 1 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 PERM ITTEF,�