HomeMy Public PortalAbout9671 LONGDEN AVE_Sewer__ IDEPAIV MENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY .�;,y PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENC3INEER B iEb►SG
ADDRESS 9675 E. Longden Ave.
FOR APPLICANT TO FILL IN LOCALITY Tmple City
BUILDING
NEAREST
ADDRESS 9675 19. LOn0en Ave. CROSS ST.
LOCALITY TempleCity DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
RECEIVED BY t Ready for Inspection DATE ISSUED
OWNER Don Richardson
MAIL
ADDRESS 110 La. .Sierra Dr. USE ZONE OCCUPANCY MAP
� BK PG
' L"
CITY Arcadia., Do 70583
CONTRACTOR A. 1. Crame & Son CO.IMP.NO.
ADDRESS 15008 E. Klondike Ave. JOB NO.
CITY Paramount, CaliftELAO. Me 360 TRUNK PERMIT NO.
/ STATE
REGISTRATION NO. C. 42.111228 H COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. WeSt 132 f. of LOt 8 STATE ENCROACHMENT
PERMIT NO.
BLOCK 1 TRACT %ntia. Anita Land Co. INDUSTRIAL
SIZE OF LOT NO.8F BLDGS. 6
WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS Dwelling CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.80 RECEIPT NO. ( DATE i BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER R OREPAIR EXISTING NO- DATE 8Y
SEWER OR DISPOSAL SYSTEM_ 1.00 l
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAI_NFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS----_..............DAY OF-......-...._.........................19...___ NEW HOUSE SEWER I}—
OWNER OR CONNECT ADDITIONAL I
OWNERS AGENT.,.........................................____.................. BUILDING OR WORK 1
SEPTIC TANK.SEEP.PIT($)
ADDRESS__ ...-------___.............................................--------- AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL(�
.AT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE SEEP.PIT(S)E� CESSPOOLS[]
OF PERMITTEE:1_- 4:_-..-;- _.•----- _
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