HomeMy Public PortalAbout9649 LONGDEN AVE_Sewer__ 7f,AE66
E•853 1 t-Su APPLICATION FOR PERMIT 1.
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LANIBIS, COUNTY ENGINEER
CASSATT 0Gh1F:=IN. SUt'rbF E",[Lci .; LOCALITY
NEAREST
FOR APPLICANT TC3 FII„: IN-
D'cSCIR1PTI0N . . LOT NO ":� � �'. ��` ,- GINNER
--` 71O N Lrd
SAIL
BLOCK TRACT - �=ytJ7' �' ! ADDRESS Y ;w ,. - "
SIZE OF-LOT - _NON!ON LOT : '%" CITY TEL. NO.
USE OF — --
BUILDINGS y r „rd. DISTRICT NO. _ �. GROUP MAR
BK P
CONTRACTOR
D
ADDRESS�_.,ECONNECTION— A --`-- --- —_
STATION f DEP"CN,
CITY �,',, 5- TEL. NO. I + :r`} —
:MANHOLE REFERENCE •4, PER r
s
REGISTRATION N0.
L COUNTY
;at> DFSC_R PTION OF 09K- FEE --_.__ ---------------------------_.__--_--
3TANK, _ _ ------ - F ---I .. . TYRE CURS ICTION P.LLENGCH-FROM
HOUSE -MNJU5E SEWER'CONNECTING TO y,PUBLIC SEWER M.L.TO P.L.
EfTIC TaA, EPA E PIT OR
PITS --_moi-
AND H URAINFILLU (i. $.,,OCOVERFLOW SEEPAGE P11,DRAINFIELD ' r P CN0.
LXTN .CESS OOL.I)RYWELL.MANHOLE (t' $2,00.j _ � CO_IMPNO. �^ �-_.IOB NQ___,.----HOUSE -^-�'--
_--_- SEWER CONECTING TO
PRIVATE DISPOSAL SYSTEM 'BUNK PERMIT N0. ROAD PERMIT NO4
+ �>
CONNECT ADDITIONAL BLDG.OR �i STATE ENCROACHMENT
WORK TO HOUSE SEWER ca" $7.00 PERMIT NO.
ALTER,REPAIR OR ABANDON 14OUSE
INDUSTRIAL
' EWFR OR DISPOSALS STEM (3 y 7.CU I � WASTE APPROVAL
f CHARGES
i
CINNECTION CHARGE FEE
OWNER'S PERMIT 00 - --—----._._ __ --- - ---------
At7THORIZATION TOTAL £EE �I REIMBURSEMENT FEE
APPROVALS DATE I,NSPECT0R'S SIGNA'IUQEI HAVE ATT IC DATE . CONTRACT WITH THE; HEREIN NAMED CON- _.------.---_--__-- _-_—_[---- ----!—__-__- -_-____ __--_-_
TRAC JR TO CONNECT. THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC. S'WER. NEW HOUSE SEWER I... I..
SIGNED'THIS—_ _DAY. .f__
19 - CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK _-----_-�—�--,
OWNERS AGEV7 - -- SEPTIC TANK,SPEP.PiT(S --- ..- -- -
ADDR_CSS _ AND DRAINFIE:LD
_ _ --'- ---_. ------- ---------- -.._.
i HERcB ACKNOWLEDGE THAT I HAVE REAR THIS APPLICATION CESSPOOLC] DRY'WELL[l i
ANO S;ATF. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -_- ___
WITH
WITH ALL. COUNT OPDINANCES ARID STATE; LA-VVS REGULATING ALTER REPAIR,SEWER OP.
PLUM BiN6 A.tID SEWERS• SEWAGE DISPOSAL SYSTEMJJ.-----
I HEREBY CERTIFY THAT I AIS PP,OPERLY REGISTERED AN •OR DISCONNECT PLUG AND
LICENSED AS REQUIR D BY I.QS�ANGELES COUNTY A#try ST T ,OF., Ag PIP
HOUSE SF.JER
CIA�IFJORNIA _ �Ix - jr ;, ,� w,.-a�-. SFFLTtSE, CTASPOGLS{�R TH i h iJE LEG L Jt4N'H Tr.E 90V ESIDEN A R G U - £+# .' Ilt"S,�^I. ` �. I _.) --
OF PFPiMITT �—
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATI® ROBERT A.WOOD, CHIEF'PLBG, INSPECTOR
CK. M.0. _v A "
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