HomeMy Public PortalAbout9610 LONGDEN AVE_Sewer__ DEPART3fENT OF COUN-TY ENGIN'FXR SEWER-SEWAGE DISPOSAL. 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY LOS 1ES t `—
WILLIAM J. FOX, COUNTYNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING �` NEAREST !"
ADDRESS '1r� A 0,�h. CROSS ST.
LOCALITY s DISTRICT NO. SERIAL NO. PERMIT NO.
-NEAREST � A C
CROSS ST.
RECEIVED 8Y Ready for Inspection DATEISSUED UED
MAILOWNER f�L�g'- � / ,'fc'�Ue�
ADDRESS .'1/ (� USE ZONE OCCUPANCY BK MAP PG
CITY GL~ C.-i r YEL.NO. �I `
CONTRACTOR
CO.IMP.N0.
ADDRESS ji2C S
JOB.N0.
CITY TEL.NO.4 aQ 4'4V f TRUNK PERMIT NO.
r� STATE
REGISTRATION N0. J + ' COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0.
-- PERMIT N0.
BLOCK TRACT <7 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTI NO.OF BLOTS.
USE \
NOW ON LOT CHARGES r
___ .'
BUILDDINGS CONNECTt6N CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 t ` ': RECEIPT NO. Rltl E !SY
HOUSE SEWER CONNECTING TO `
PRIVATE DISPOSAL SYSTEM Lou
CONNECT ADDITIONAL BLDG.OR "EXCEPTION RECORDED_''_
WORK TO HOUSE SEWER 1.00 I
ALTER OR REPAIR EXISTING NO. DATE BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION `i DEPTH
CESSPOOL—DRYWELL -
SPECIAL CONDITIONS ONLY 2.00MANHOLE REFERENCE
,ism .l LOWER
PE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I I 00
Y. - s__ M.L-TO P.L.
AUTHORIZATION I TOTAL FEE I •-I. �c -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER �1 — -
SIGNED THIS./...... AY OF___ .G���� 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
//� /f- BUILDING OR WORK
OWNERS AG5NT. .-.:.._7.....%S -LG_f- _.._.._.._..._._».»..
(3 i �+f } SEPTIC TANK,SEEP.PIT(S)
ADDRESS---.-e.2...__..____._..__.__. c.._._?. i.w1_:».................... AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS
�
SIGNATURE SEEP.PIT(S)[3 CESSPOOLS n
F PERMITTEE ._ = ...... - --.... ---------
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