HomeMy Public PortalAbout9656 LONGDEN AVE_Sewer__ -E808 10-62
`6.4 6+12D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING BUILDING AND SAFETY DIVISION BUILDING
I'D
ADDRESS
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building
LOCALITY
FNEAREST
CROSS Sr.
FOR APPLICANT TO FILL IN
LEGA-C
0��SC RIFT[O�4 LOT NO� OWNER
MAIL
BLOCK TPA r
ADDRES� I,
NO. OF SL.DGj.
SIZE*, OF LOT NOW ON LOT CITY rE.L. NO.
USE OF ROU. IAP PROCESSED BY
BUILDINGS PROFESSED
R
B K 'Y
CONTRACTOR
"0,
ADDRESS
CONNECTION DATA
CITY TFL. NO. SiATAO DEPTH
Q STATE:
15'1 RATION NO. Y MANH.Oi E REFERENCE
REG
COUNT LOWER
NO. EEs_Em_4'T10L'd
TI0N LENGTH PROM
Y �6,1_
HOUSE 5EWER
N I cmNis i7i MA TO P.L.
PUBLIC � _i SEWER @ S5,00
P.C.NO.
E,r. - N-SEEPAGE___ ---
I&TA K, Pf_� OR Y
CO�IMP_NO. JOB NO.
PITS AND, DR�MNFIEL.D $10.00 _4
SE:SEWER CONN rcr_TN-_-TO
T RUNK PERMIT"NO. ROAD FIERMITNO.
PRIVATE D!SPOSAL SYSTEM @ $3.00
z
CONNECT.ADDITIO -------- RE-CORD.ORR 6-,1 4�4�R 14 6 T1 DATE
NAL 61.06, WA
WORK TO HOUSE SEWER @ 53.00
OV ER FF LOW SEEP A G E PIT._6R-A iN-F-1 E L D ---
EXTN :CE Sqf1OOL,DRYWFLL,MANHOLE a 35.00
HWY.OR ST.WiDEINING
LN
AL ER,RPAiR OR ABANDON HOUSE
ORWSPALSYSTEM $3.00 STA- TEENCROACH-MrNT
PERMIT NO,
-------- INDUSTRIAL
WASTE APPROVAL
CHARGES
2: 00
OVMER TS --I FER-M-1-IT s F
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON RE;MBL)P.SEMFNT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
1.
0 THE
HE rUBLIC SEWER APPROVALS DATE iNSPECTO W5,SIGNATURE
Si GN ED TH[S___DAY 0 9.-._ -j L OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL:
ADDRESS
BUILDING OR WORK
--------------- SEPTIC TANK,SEEP.PIT(S)
HE ACKNOLFDSEVTHi r I HAVE READ THIS APPLICATION
I W AND/OR DRAINFIELD lI
AN STATE THAT ZHE ASO E 5 CORRECT AND AGREE TO COMPLY
W:TEI ALL COUNTY ORD!NANCES AND STATE LAWS REGULATfNG
LUMFifNG AND SEWERS. CESSPOOL
CI DRYW_ELL__[]___
ALTER,REPAIR. . _i-__
------------
I HEREBY CERTIFY E.',)THAT I AM PROPERLY REGISTERED ANDI�OR WL R,REPAIR.SEWER OR
LI�FNSFD AS REQUIRBY LOS ANGLES COUNTY AND STATE.- OF SEWAGE DISPOSAL SYSTEM
CA"fFORNPA OR 11,AT 1 AM THE LEGAL OWNER OF :AND INTENDTO
I CON
RESIDE !NT THE ABOVE DESCP,�BEO RESIDENTIAL PROPIERTY. ABANDPd ECT PLUG AND
ON HOUSE SEWER,
SIGNATURE
OF PERM17TErBA1_
CK�115EPTICTANKS
5-F.Ep,piTLS) L CESSPOOLS E]i
ROBERT A. WOOD
Icy
C CASH SUPERVISING MECHANICAL ENGINEER
M 0
p.v
-08 10-62
7FJA64,-D APPLICATION FOR PERMIT
-OUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
L'1-GING
BUILDING AND SAFETY DIVISION BUILDING
1' 3
ADDRE53
101-IN A. LAMBIE. Counky Engineer
WILLIAM A. IENSE-N, Su?'t of Building
L 0C LTY
I
OCALTY
NEAREST
-S . ','r,r11
FOR APPLICANT TO FILL IN CROSS T
R,F-,!ON LOT NO. OWNER
MAIL
2L.Or— 'TRACT
ADDRESS
NO OF 61-TiGS.
,
SIZE 0N.�I
0' 1-07 V'j ON LOT CITY
TEL. NO.
LDINGS DISTRICT NO.11 GROUP MAP
PRc)CE-s$cD BY
BK
PG
v
ADDRESS CONNECTION DATA
STATIC;, DEPTH
CITY TELI NO.
-40 STATE MANHOLE..11-ENIE
REG!STRATION H Y LOW
COUNT
j E TY; OF CON LE GT--"F N�
D-ESCRIPT(ON OF WOR-- FE N 11
HOUSE SE Y.
CONNECTING TO L, WL.TO PA- U
PUBLIC"EWER
P.C.NO,
E F�Ti -i'A N C 0, 1.14 P NO. JOB NO.
PFTS DRAINF;ELD @ $10.00
HOUSF SEWER CONNE(TING TO
rRivA Disp SAL SYSTE @ $30 TRUNK PERMIT NO. ROAD PERMIT N
CONNECT ADDITIONAL BLDG.(YR-- -AFFI�DA-W-T—' W-A V-E-F. (N -N-0 DATE
IWORK TO HOUSE SEWER @ $3-00
70 VE FILOW SEEPA G E PIT,
EXTN.,,'�ESSPOOL,r)RYWi�LL.,.MA?qH OLE@ $5:00 ------
AL45-R-,REPAIR O-RA8-A--NdO-NH60SE----- HWY.OR ST.WIDENING
SLIWER Up DISPOSAL SY$TFM @ $3.0c)
STATE ENCROAC
HMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OVVNER'S PERMIT CHARGES
CQNNECTION CHARGE FEE
A=ORIZATION TOTAL FEE ----- --
I HAVE ATTHIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
T R&CTOR To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
THE SLiC SE',VER. .APPROVALS To PU OVALS DATEI INSPECTOR'S$101`SATURE
SIGNED T'tl;S,-,—DAY OF-------19—
OWNER OR _NEW HOUSE SEWER
OWNERS
CONNECT ADDITIONAL
_BUILDING OR WORK
--�- -I--- - - - --
5 f;T C TANK,SEEP,PIT(S)
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/QR DRA!NFfELD
AND STATE THAT 714E ABOVE IS CORRECT AND AGREE I'D COMPLY
W,fH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING
PL.U M,B ING AND SEWIER6, CE55POOL D' DRYWEL Lj
1-SERE3Y CERTIFY THAT 1 A PROPERLY REGISTERED AND/OP ALTER,REPAIR,SEWER OR
LICENSED AS, REQUIRED BY LOS ANILFS COUNTY AND STATE 01 SEWAGE DISPOSAL SYS-1 Em.
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO tko`NNEc--r PLUG —AND-
BESIDE IN. THE ABOVE OESCRfICO RES I DENT iAL',�ROPERTY -OU�
ABANDON SE SFIVER__
SIGNATURE
OF PERIAITTEE SAC KF I LL S P ICTANKS
-7 CESSPOOLS 01
SEEP, IT 5)
VALIDATION ;�
ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CKI M.0- CASH