HomeMy Public PortalAbout9641 LONGDEN AVE_Sewer__ 7GA
E-663 3.55 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER- SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING51 4t
WM.J. FOX. COUNTY ENGINEER ADDRESS �
CASSATT b.GRIFFIN,SUPT OF BUILDING LOCALITY
_ FOR APPLICANT TO FILL IN NEAREST
LEGAL -
_ DESCRIPTION LO7 N0. _ OWNER A .: .:
F MAIL
BLOCK
�+�' TRACT - IL
- '� ec _ ADDRE55 --
GS
SIZE OF LOT NO OF BL
NOW ON LOT
Ci7Y £��w� TEL. NO.
USE OF ,c1
BUILDINGS_ i-•-�'C'- �� DISTRICT NO. GROUP ! MAP
BK"-- - tee•
CONTRACTOR _ .`tr P,�rGr-:.
ADDRESS 1® r ,d � '�� -- — — CONNECTION DATA �—
CITY TEL. NO. STATION h DEPTH
— s STATE MANHOLE REFERENCE
REGISTRATION NO. _ � .; C.� COUNTY - _ -- s%dA-ll°
DESCRI,T,,N OF ASRI FEE
TYPE QFte7RwiECTtON LENGTH FROM
HOUSE SEWER CONNECTING TO —` �.�y Y {CURB `� „y� -� h1.L_TO P.L.
- PUBLIC EWER _ $ 3.50
--� ---� ,s - -
HOUSE SEWER CONNECTING TO
— PRIVATE DISPOSASYSTEM
1.00
CONNECT ADDITIONAL BLDG. CR - •-"r,. - P C NO.
WORK TO HOUSE SEWER_ 1.00CO. IMP. NO. �� �5 --=°- JO? No.
f ALTER OR REPAIR t6IS1ING
SEVVER OR DISPOSAL SYSTEM 1.00 _ J _ TRUN•� PERMIT NO. ROAD PERMIT NO, 7 �' j'
DISCONNECT AND ABANDON SEWER --'-- ------- --_._ __—____ _
AND/OH DISPOSAL SYSTEBI 1.00 S7kTE ENCR OACHIdEN7
�- PERM NO.
SEPTIC TAIJY, SE ?AGE PIT OR INDUSTRIAL"�
_ p175 AND/GIT DRAiNFIELD 00 WASTE APPROVAL
DRY NFL,.
SPECIAL COPa DIT ONS ONLY 2.00 CHARGES �-
OVVNEA`S PERMIT $�- 1 -DC CONNECTION CHARGE FEE - -
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED C.ON•
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE f
TO THE PUBLIC SEWER _._ .��.__.
w* NEW HOUSE SEV,'ER
SSGlJEDTHIS _ —$,,DAY OE
OWNER OR .1". '71""' CONNECT ADDITIONAL
OWNERS AGENT ,e. BUILD!?.G OR utORK— _
`SEPTIC TANK,SEEP, PIT(S)
ADD E - ..y ^� - :-• AND/OR DRAINF(ELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[I DRYWELL 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE Ta COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, ALTER, REPAIR.SEWER OR
EWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -_SEW --.-_- - - --
LICENSED AS REQUIRED BY LOS ANGELES COUNTY .AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNE7'OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. /� BACKFILL SEPTIC TANKS C 1
"- SEEP. PIT0S} CESSPOOLS�
t �•� sj,�''
SIGNATURE `,� e�
OF PERMITTEES ✓'` --
WILLIAM J.FOX, COL) ENGINEER VALIDATION R.A.WOOD, CHIEF FLOG. INSPECTOR