HomeMy Public PortalAbout9662 LONGDEN AVE_Sewer__ 70A642D
F-663 11.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER AM2URSS Z'
CASSATT D. GRIFFIN, SUPT QF BUILDING
OCALIT'Y
NEAREST
FOR APPLICANT TO FILL IN GROSS ST.
LEGAL
PMAIL
BLOCK TRACI', ADDRESS
J
D OWNER
ESCRIPTION LOT NO.-4—
AL
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
----
B.UILDISTRICT NO. GROUP
BK MAP PG
CONTRACTOR
ADDRESS CONNECT - .
ION DATA ___
Pa"
STATION DEPTH
TEL NO UPPER
1112�11 C-- 4 MANHOLE REFERENCE
STATE 'NER
REGISTRATION NO,. 0 COUNTY
NO. 1 DESCRIPTION OF WORK FEE
iz'Y f
TYPE OF CONNECTIO LENGTH FRO
EWER Y. CURB P.L. M.L. TO P.L.
HOUSE cc;�wi
I PUBLIC SEWER @ $ 3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD- (a- $3.00'
OVERFLOW SEEPAGE PIT, DRAINFJELD P. C. NO.
EXTN_CESSPOOL,DRYWELL,MANHOLE $2.00 —CO. IMP. NOS
HOUSE SEWER CONNECTING TO
C N¢---
N 0
TRUNK PERMIT NO. AD P E MIT'NO,
PRIVATE DISPOSAL SYSTEM ca $1.00
\PER-1—
CONNECT ADDITIONAL.BLDG.OR STATE ENCROACHMEN
WORK TO HOUSE SEWER 61 $1.0-0E
PERMIT NO,
ALTER,REPAIR OR ABANDON HOUSE I INDUSTRIAL
-SEWER OR D.ISPOSALL SYSTEM GO
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 5 1 00
I
REIMBURSEMENT FEE
AUTHORIZATION I ;P-, Vr_(
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCON-
APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR 10 CONNECT THE ABOVE DESCRIBED EXISTING-DWELLING
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THISDAYOF___I9_____ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS--, AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLO DRYWELLE)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS.
ITH ALL COUNTY ORDINANCES AND STATE LAINS REGULATING SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTiAL-PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE SEEP.PIT(S) I__1 CESSPOOLS 0
OF PERMITTEE %If
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.0.
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