HomeMy Public PortalAbout9673 LONGDEN AVE_Sewer__ 'DEPAWrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS Yj E. Longden lye
FOR APPLICANT TO FILL IN LOCALITY Temple CiBUILDIG NEAREST
t;
ADDRESS %7,5. V� Lon�gdan AV@a CROSS ST.
LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER Don RiCharxwri
MAIL
ADDRESS 110 La. Sierra Dr. USE ZONE OCCUPANCY BK MAP PG
CITY Arcadia, Calif.. TEL.NO. Do 70583
CONTRACTOR A., L. Cape & Son CO.IMP.N0.
ADDRESS x 15005 E. Klondike Ave.
JOB N0.
CITY ParaMoUnt' Ctalifl'.EL.NO. Mer 36089 TRUNK PERMIT NO.
STATE
REGISTRATION NO. C. 42.11.1225 ❑ COUNTY
B ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. West 132 ftp of Lot 8 STATE ENCROACHMENT
PERMIT NO.
BLOCK 1 TRACT Santa* Anita Land CO. INDUSTRIAL
— WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. 6 CHARGES
NOW ON LOT
USE OF
BUILDINGS Dwelling CONNECTION CHARGE FEE
NO. i DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
�NOUSE SEWER CONNECTING TO
PUBLIC SEWER_ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
_PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM EGO CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFiELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION 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
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..................._....-............._.._--__. ........ BUILDING OR WORK
..._................
SEPTIC TANK.SEEP.PIT(S)
ADDRESS.. _......-...._.. .......... __ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
CATION 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
I HEREBY CERTIFY THAT 1 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 ABOVEL._DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS E]
S'GNATURE
OF PERMITTEE-: ...Q ( .:.._--
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