HomeMy Public PortalAbout9660 LONGDEN AVE_Sewer__ Y6AE
E•-663663 19.38 APPLICATION FOR PERMIT- ` 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING yyy
JOHN A. LAMBI:E, COUNTY ENGINEER ^ADDRESS
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CASSATT 0. GRIFFIN, SUPT OF BUILDING LOCALITY r s,,,,.
NEAREST -- i--
-FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO.. ' �'d --- OWNER 4� c
-'-- MAIL
BLOCK TRACT j'"'•- /�"„ ADDRESS —_ � ✓- — +.:��,.'.__.Y„--
NO.,OF BLDGS. A CITY TEL. N0.
SIZE_OF LOT NOW ON LOT i
USE OF - ^-�-- —�-- ---- DISTRICT N0. GROUP ( MAP
BUILDINGS.-- BK PG
CONTRACTOR41—v 7 d .
CONNECTION DATA
ADDRESS y� o ^� -{- - ---- -------�--- -- --- - ----._.._ _
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. STATION DEPTH
CITY TEL.NO. J y {��/v -
--- -- ✓, ! ._ _ MANHOLE RE ERE�NCE �` '-- iwww.i..
/ )�E�tTE ___ __ _ __ � '�'+� �•`` LOWER
REGISTRATION NO.
/ El COUNTY
NO. DESCRIPTION OF WORK FEE -- --- ---- ------
TYPE OF CONNECTION vLENGTH FROM r
-� HOUSE SEWER CONNECTING TO Y� CURB P.L. M.L.TO P L
-PUBLIC SEWER (� r 3.50 .> ✓' --- -- —
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD_ __fd $3.0_0 _ _ ------i_._ -.-- ---- ----. ----
1 OVERFLOW SEEPAGE PIT,GRAINFIELD P C NO•
EXTN.,CESSPOOL,DRYa4ELL,MAN HOLE Ca $2.000CO. IMP. NO.
HOUSE SEWER CONNECTING TOf-
PRIVATE DISPOSAL SYSTEM. <_.0 $I.00TRUNK PERMIT_NO. ROAD PERMIT NO.
I CONNECT ADDITIONAL BLDG.OR �I- STATE ENCROACHMENT
WORK TO HOUSE SEWER--_-_ g_L.00_� _ _PERMIT N0.
ALTER.REPAIR OR ABANDON HOUSE I"{OUSTRI,AI.
SEWER OR DISPOSAL SYSTEM C $1,00 _ WASTE APPROVAL
CH GE
-_ CONNECTION CHARGE FEE
OWNER'S PERMIT . -� - -
-�.-_ ____.-------_ _--
1 O� REIMBURSEMENT FEE
AUTHORIZATION TOTAL PEE ,;
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS I DATE 1N8PEC70R SSIGNP7 URL
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
TO Ti'E PUBLIC, SE"WER. _ - NEW HOUSE SEWER
SIGNED THIS DAY:0F �,' 19 --�_ -_�._.. — -
y: CONNECT ADDITIONAL
OWNER OR .. BUILDING OR WORK
OWNERS AGENT y -- -- -- - -
y, SEPTIC TANK,SEEP PITIS) 1
ADDRESS "Ly' ."� AND/OR DRAINFIELD i.._.
_ tikes -THEREBY ACKNOWLEDGE ACKNOWLEDGE .THAT I HAV 'READ THIS APPLICATION
' CESSPOOLr,-] O
AND STATE THAT THE ABOVE 1S CORREC.'f AND AGREE TO COMPLY
Wf.IF ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR j
PLUt,IbING AND SEWERS, SEWAGE DISPOSALSYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR _ - -
L1 ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF. DISCONNECT USE SELUG W D
LA LI=ORTl1A OF lHA7 I ,4 TE LEGAL NR OF THE ABOVE ABANDON N6I,SE SEWER
DESCRIBED RESIDENTIAL- OPER7HY. 'f BACKFILL SEPTIC TANKS
SIGNATURE SEEP, PIT(S) J CESSPOOLS L-3 i_.-____-
A ----.----------' ----
OF PERMITTEE -
I
JOHN A. LAMBIE.CC9 NTY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF P BG. INSPECTOR
CIS. *.-OCASH �,,