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Home My Public Portal About9663 LONGDEN AVE_Sewer__ CE808 3-Ea J 6A 642D APPLICATION{ F -� PERMIT COUNTY OF LOS ANGELES SEWER_SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS #A _ _ WILLIAM A. IENSEN, Supt of Building LOCALITY NEAREST FOR AEMA 'L aJ CROSS ST. - LEGAL _DESCRIPTION _LOT NO. OWNER MAIL BLOCK _TRAC--v.1 �� .ray,.- .: ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OIF DISTRICT NO. GROUP MAP ,*$RO E5SED BUILDNGS BY PK s" CONTRACTOR J i- - C -� / ADDRESS CO_NNECTI.O DATA _ CITY . ;i".--TEL NO. 7,T!T1.1 J,f� DEPTH 44 -w--s°--- �-zJJ rf' REGISTRATION NO. _ � TAT MANHOLE REFERENCE - ,�/ - �T ��_ ❑ COUNTY ' t+' t' Al LOWER NO. I MESCRIPTI4N OF WORK FEE TYP OF CO E N, LENGTH FROM �...� HOUSE SEWER CONNECTING TO —� Y. = y`�^ � ga L. M.L.TO P.L. PUBLIC SEWER @ $S.00 I - - :. SEPTIC TANK SEEPAGE PIT OR 'r JOB NO. ®' PITS AND/OR DRAINFIELD @ CO.IMP.NO. -_ I HOUSE SEWER CONNECTING TO I TRUNK PERMIT NO. ROAD PERMIT NO. }��( -_- V PRIVATE DISPOSAL SYSTEM $3.00 CONNECT ADDITIONAL BLDG.OR ^"--� .AFFIDAVITWAiYER EASEMENT RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER $3.00 O OVERFLOW SEEPAGE PIT,DRAINFIELD I _ EXTN.,CES SPOOL,DRYWELL,MANHOLE @ $5.00 W ALTER,REPAIR OR ABANDON HOUSE12. HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM _ @ $3.00 I STATE ENCROACHMENT a I -T -_- � t- PERMIT NO. __- --- ^-�-r-r _- _ INDUSTRIAL i WASTE APPROVAL OWNERS PERMIT _$ 2 OO CHARGES - CONNECTION IIARIE FEE AUTHORIZATION TOTAL FEE ' --- -- -I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING. ----- TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'SSIGTI TUR.. SIGNED THIS �.DAY OF--,-19— OWNER F —. 19_OWNER OR J� {,_ NEW HOUSE SEWER_ OWNERS AGENT L CONNECTADDITIONAL F BUILDING OR WORK ADDRESS '—_ _-__--_ SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -�-- �— - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL I HEREBY CERTIFY THAT t AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE D ISP05AL SYSTEM .CALIFORNIA OR THAT i AM THE 1_EGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND- RESIDE IN, THE ASOVr,DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE -BAC KFILL.SEPTIC TANKS ❑ OF PERMITTEE J ♦` _ _ C]'SEEP.PIT(S) CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER , +''J CE808 3-64 '76A642D APPLICATI014OR PERMIT COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 7SS JOHN A. LAMBIE, County Engineer ADDRE WILLIAM A. JENSEN, Supt of Building LOCALITY L [ A NEAREST FOR AlIPLIC ,TO CROSS ST. PANT L LEGAL SC RIPTION LOTH WNER _DE �21'1 MAIL BLOCK TRACJ- 71�1'_ ADDRESS NO. OF BLDGS. SIZE OF LOT NOW 0-N LOT CITY TEL. NO. USE OF DISTRICT NO 0"1 B. MAP 1'. CESSED BY BUILDINGS Jti CONTRACTOR ONNECTION'DATA ADD ESS D� S TION /,1* DEPTH IT TEL. NO, 1-4 5- ,❑ I STATE MANHOLE REFERENCE REGISTRATION NO. D COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPE OF C4N N LENGTH FROM ✓ HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. PU_ LIC SEWER � $5.00 C _ P.C.NO. SEPTIFANK,SEEPAGE PIT OR CO MP.NO. JOB NO, 9L OR DRAINFIELD @ $10,00 —1 PITS / 0 }4_6_USIE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U PRIVATE DISPOSAL SYSTEM @ $3,00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER $3.00 IF OVERFLOW SEEPAGE PIT,DRALN ff EXT N._,C E S SP 00 L,D RY W EL L, /WHOLE @ $5.00 ALTER.REPAIR OR ABANI D HWY.OR ST.WIDENING JSCWE-ROR R DISPOSAL 5 @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL7' C-HARGk OWNERS PERMIT CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 4_1 It:- .1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED Cl�NREIMBURSEMENT FEE - TRACTOR T CONNECT THE ABOVE DESCRIBED EXISTING DWELLING H PUBLIC APPROVALS 'S SIGNATURE TO THE USLIC SEWER, DATE INSPECTOR'SSIGNAT RE SIGNED THIS—DAY OF OWNER OR 4' HOUSE SEWER Al"t- OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS.,.- SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANDOR DRAINFiELD AND D STATE THAT THE ABOVE IS CORRECT AND AGREE TO ,' COMPLY W!THALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLU Me IND AND SEWERS. EW r RS. CESSPOOL [I DRYWFLL 0 S HEREBY CERTIFY THATIAM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL.SYSTEM CALIFORNIA OR THAT_1_,AM THE LEGAL OWNER OF, ANO INTEND TO DISCONNECT PLUG AND RESIDE ES D E IN, THE ABOVE ESCR P�ESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIOF PERMITTEEGNATURE BACKFILL SEPTIC TANKS ❑ SEEP.PIT(5) El CESSPOOLS VALIbATI ON ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M_O. CASH Fz