HomeMy Public PortalAbout9675 LONGDEN AVE_Sewer__ Dil7PAWiMENT 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 9675 Cr a,N. t�o>itgden Ave.
�F�O�jRAPPLICANT TO FILL IN LOCALITY Timpl.e City
BUILDING
ADDRESS 67-5-- E. Longden Ave. NEAREST
_ CROSS S7.
LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
OWNER
I)OA Richardson RECEIVED BY Ready for Inspection DATE ISSUED
ADDRESS 110 La. Sierra Dr. USE ZONE OCCUPANCY MAP
BK PG
CITY Arcadia, Calif.TEL.NO. Do 70583 I+
CONTRACTOR A. 1. Crume & Son
— Cp�r� CO.IMP.NO.
ADDRESS 150008 E. Klondike Ave. JOB NO.
CITY Paramuntp WiEGL.NO. Mes' 3()08 J TRUNK PERMIT NO.
STATE
REGISTRATION NO. (;., 42.111228 H COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. VeLgt ' '� Pt AF IR1t $ STATE ENCROACHMENT
PERMIT NO.
BLOCK 1 TRACT Ssntai Anita land Co. INDUSTRIAL
SIZE OF LOT N0.OF BLDGS. WASTE APPROVAL
NOW ON LOT 6 CHARGES
USE OF
-BUILDINGS Dwrellinit CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
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• DATE 11
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINF!ELD 2.00 STATION DEPTH
CESSPOOL--DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LGwEB
TYPE OF CONNECTION LENGTH 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.........................-_----_-_..v_-.:._---.-----_---_--_-----_-•-_.__.._. BUILDING OR WORK
ADDRESS...__.......................•_.----•----•--__-...._...---•.-..-...--•-...___....•-_--•-. SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 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 I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT ! AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE.I)ESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)E] CESSPOOLS E]
r
OF PERMITTEES . S..w._._, # .4,.A -- ... -
76A642D 663 1/53