Loading...
HomeMy Public PortalAbout9627 LONGDEN AVE_Sewer__ '6A -61 '6A6423-61 APPLICATION FOR - ERMIT 6A2 COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �, Y JOHN A, LAMBIE, County Engineer ADDRESS }� �� s° � ' WILLIAM A. JENSEN, Sug't of Building LOCALITY - �� .°yT FOR APPLICANT TO FILL IN CROSS SSTT. LEGAL / % OWNER < - DESCR%PT%ON LOT N0. ADDRESS BLOCK TRACT a "tel w r r .� NO.OF BLDGS. $rT f g�. SIZE OF LOT ( I NOW ON LOT CITY STEL. N0. USEUSE OF DISTRICT N0: GR-OEYP MAP PROCESS D BY +J t 7 % ! SK PQ CONTRACTOR y ,.Y _ fj / tl �1 J ADDRESS <y— t C:OI�INEGTION DATA t'«� DEPTH CITY J.: TELKO. 3 STATION �:,- - -�s STATE MANHOLE REFERENCE y' REGY:STR.ATION NO. COUNTY a, -' '� LOWER No. % DESCRIPTION OF J RIS FEE y HOUSE SEWER CONNECTING TO - PUBLIC SEWER •00 & , TYPE OF CONNEOTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. t_UURB P.L. M.L.TO P.L. PITSAND,�ORDRAINFIELD (s) $3.00 - OVERFLOW SEEPAGE PIT.DRAINFIE'LD °a- EXTN..CESSPOOL.DR YWELL @ $2.00 _ O P.C.N0. PRIVATE DISPOSAL SYSTEM TO @ $I.00 CO,IMP.N0, � n !08 N0. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. �.� d.f WORK TO HOUSE SEWER @ SLOO O SEWER.OR DASPQSAL SYYSTEM HOUSE @ $1.00 STATE ENCROACHMENT r _PERMIT N0. INDUSTRIAL 6Lt CL WASTE APPROVAL N CHARGES Z swiL O'��mws PERMIT $1 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FES I Z,r zY) REIMBURSEMENT FEE iMED CON- T ACTOR ATTHIS CONNECT THE AB©VETDESCRIBED EXIISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS._,L�DAY OF r_Z1.dc 19`" NEW HOUSE SEWER _ OWNER OR .� CONNECT ADDITIONAL OWNERS AGENT �,.y --,1 ,.i.Q �}W �°'�r �--�.w � BUILDING OR WORK --- -- �� _ SEPTIC TANK;SEEP.PIT($) ADDRESS—ZS _.`... �� AND/OR DRAINFIELD I HEREBYACKNOWLEDGE THAet HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL I] DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - ALTER,REPAIR,SEWER OR { PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OW ER OF THE ABOVE -----�••�•- --°-- DESCRIBED RESIDENTIAL PRp RTY ..,,. BACKFILL SEPTIC TANKS -.�-�' SEEP.PITS C�. CESSPOOLS SIGNATURE OF PERMITTEE °''� ` VAMATIOO ROBERT A.WOOD sK. M.o. CASA SUPERVISING MECHANICAL ENGINEER r'7