HomeMy Public PortalAbout9654 LONGDEN AVE_Sewer__ 76AE42D 62 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
B
JOHN A. LAMBIE, County Engineer CURESS
W1111AM A. JENSEN, Supt of Building
LOCALITY
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AC
DRESS
FOR APPLICANT TO FILL IN CROSS ST.
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DESCRIPTION L 0 T NO, 44 OWNER 4�7 �Y
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BLOCK _e, MAIL-FADDRESS
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NO. OF BLDGS.
A r z-
2:� 0 OT NOW ON LOT CITY TEL. NO.
�j U:1-DN G DISTRICT NO. GROUP MAP PROCESSED BY
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CONNECTION DATA
S T!0 N
T- zl DEPTH
TELNO.
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91 COUNY
MANHOLE REY-ERENCE
3N NO. LOWER
h: RIPTIQ FEE TYPE OF CONNE LENGTH FROM
14mvER 0-, Y- L. M L.TO I.L.
OW
EWER $500
0
—I�F;Wj ANK,SEEPAGE ACO.A-r-9k' JOB NO.
P!T&
ND/OR DRAINFIFLD @ $10.00 _IMF, NO.
NESTINGTO
@ 0 0 TRUNK PERMIT NO, ROAD PERMIT
4 L 6 Y S T E M
- ---- - - - --- - - ------ ------- -- - --/ , - ;I / 0
T.11156tTIONAL BLDG.OR AFFIDAVIT EA—Fr.-PNT-1 --RECO—RD,-f-NSTF�.NO DATE'
TO HOUSE SEWER @ $3 00
17 LOW SEEPAGE PIT,DRAINFIELD
�Yl-',;,,CES5POOL.L)RYWE:LL.M.ANHOLE:@ $5.00
- ------ HWY.OR ST.WIDENING
4. EPAiR OR ABANDON-HOUSE
,R DISPOSAL SYSTEM @ $300 STATE ENCROACHM-1N1-
PERMIT N.O.
INDUSTRIAL,
WASTE AFPROVAL
CHARGES
PERMIT 21 00
ov nT ER'S�7-_---
CONNECTION CHARGE,FEr
AUTHORI ISATION TOTAL FEE
DATE A CONTRACT WiTri THE HLREIN NAMED CON- REIMBURSEMENT FEE
ONNECT THE ABOVE CESCR:BED EXISTING DWVL.L7 CI,
S kV
,c Epl. DATE INSPI:.CTOR'S,5IGNATU
APPROVALS I'd
:-)AY 0F�-__---_Iq
_NEW HOUSE SK'Nf-R
CONNEI--, ADDITIONAL
BUILDING OR WORK
SE:P1 IC TANK,SEEP,PIT(S)
C N
KNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFirLD
-THAT
A N THE AROVE IS: CORIIECT AND AGREE TO CIMPLY
C_OU
WITH ALL, COUNY
I H L , ORDINANCES ANC STATE LAWS REGULATING T
PLUMBING AND SEWERS. CESSPOOL DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
C: 1 DR N IA OR
F
AL!pORNIA_,1-)R THAT I AM THE E GAL OWNER 0 ' AND INTEND TO -D—iS-ONNECT PLUG AND
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RESIDE IN 'HE ABOVE DESCRIBED RRESiDENTI 71I�R ERTY
ABANDON HOUSE SEWER
SIGNATURI,
E
OFF
PrRMI`T TE E- SACKFILLSEPTIC TANKS
SEEPPIT(s) cESSPOOLSE)j
VALIDATION ROBERT A. WOOD
r K. M.0 C A SH SUPERVISING MECHANICAL ENGINEER