HomeMy Public PortalAbout9615-9617 LONGDEN AVE_Plumbing__ 76A642D
CE8
t i 08LREV.6/78) APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ` MAP PROC ED BY
ADDRPG
BUILDING
ESS
.y- CONNECTION DAT
LOCALITY .air J,�.�� 4,i ! `
NEAREST ��LL..� / J� STATION -j G DEPTH
CROSS ST. .,f.E;%r^y'P tet..°„r /6—if•�/ -K UPPER
MANHOLE REFERENCE LOWER
OWNER f J"ja: '! TYPE OF CONNECTION LENGTH FROM
MAIL Y. CURB P.L. M.L.TO P.L.
ADDRESS /z/ 2-s _t�✓�<f �', "�
d,�f l P.C.NO.
CITY C-J"dG/dl.ij TEL.NO. � .Z:,.�.. CO.IMP.NO. JOB NO.
LEGAL �� TRUNK PERMIT NO. ROAD PERMIT NO.
TI
DESCRIPON LOT NO.
AFFIDAVIT I WAIVER I EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT,
NO.OF SLOGS.
SIZE OF LOT NOW ON LOT a1 HWY.OR ST.WIDENING
USE OF
BUILDINGS_..,;, "�; v ;/.L� - STATE ENCROACHMENT
� PERMIT NO.
CONTRACT0�.3G G= (��( „f' INDUSTRIAL
Y E WASTE APPROVAL
ADDRESS , CHARGES
CONNECTION CHARGE FEE
CITY TEL.NO.
STATE LIC. REIMBURSEMENT FEE
LICENSE NO. CLASS
NO. DESCRIPTION OF WORK FEE APPROVALS DATE IN5PECT0 R'S SIGNATURE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER
SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWER
PITS AND/OR DRAINFIELD CONNECT
AL
HOUSE SEWER CONNECTING TO BUILDING R WORK
PRIVATE DISPOSAL SYSTEM — 4
SEPTIC TANK,SEEP,PIT(S)
CONNECT ADDITIONAL BLDG.OR ANP/OR DRAINFIELD
WORK TO HOUSE SEWER
w
OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL Q DRYWELL
EXTN..CESSPOOL,D RYWELL,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❑
OWNER'S
Permit $ SEEP.PIT(S) CESSPOOLS
AUTHORIZATION TOTAL FEE I 1 / 1. VALIDATION j 9 �y
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- l � C.4. � .�_- / / V 7
TRACTOR TO CONNECT THE 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 HE
CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
ICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
ALIFO RN IA OR THAT I AM THE LEGAL OWNER OF.AND INTENDTO BE-
IDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
IGNATURE ,
OF PERMITTEE -
76A6a2D
is 08lREV.6/78, APPLICATION FOR PERMIT
aJ5
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP MAP PR ESSED BY
j � BK PG
BUILDING CO! 31 A,;,
ADD.='S
SS /
LOCALITY /.- `✓ t` CONNECTION DA
Te
NEAREST - STATION , - DEPTH
UPPER
CROSS ST.
MANHOLE REFERENCE LOWER
OWNER - ,,� f7 - -f,cBf.` TYPE OF CONNECTION LENGTH FROM
MAIL �/,,s Y. CURB P.L. M.L.TO P.L.
P.C.NO.
CITY
` �I �'. /.r r CO.IMP.NO. JOB NO.
.; ,ryl+ TEL.NO.
LEGAL TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO. r' A/ J
_ AFFIDAVIT I WAIVER I EASEMENT RECORD.INSTR,NO, DATE
BLOCK TRACT -Z'- '—`
NO.OF BLDGS. 9
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF A -
BUILDINGS ;/.- -!"tp � STATE ENCROACHMENT
PERMIT NO.
CONTRACTOR ,y �,, / INDUSTRIAL
.{ '' - yV
-ice' ..�'..�' � WASTE APPROVAL
ADDRESSf,�;+�y,�"" CHARGES
CONNECTION CHARGE FEE
CITY TEL.NO.
STATE LIC. - REIMBURSEMENT FEE d
LICENSE NO. CLASS 0
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE V
HOUSE SEWER CONNECTING TO
PUBLIC SEWER O
NEW HOUSE SEWER
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM d
SEPTIC TANK,SEEP.PIT(S)
CONNECT ADDITIONAL BLDG.OR
AND/OR DRAINFIELD
WORK TO HOUSE SEWER s
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DRYWELL❑
EXTN..CESSPOOL,DRYWELL,MANHOLE
ALTER.REPAIR OR ABANDON HOUSE ALTER,REPAIR.SEWER OR
SEWER ORD ISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS❑ _
SEEP,PIT(S) CESSPOOLS J
OWNER'S Permit s
AUTHORIZATION TOTAL FEE VALID TION
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. '
SIGNED THIS DAY OF 19_
OWNER OR
OWNERS AGENT -
ADDRESS
IHEREBY 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. -
1 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