HomeMy Public PortalAbout9700-9702 LONGDEN AVE_Sewer__ 76A642D -
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ops 08(REV.6/78) APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT N0. GROUP BK PG MAP PROCESSED BY
BUILDING ,,.+
ADDRESS L." '!.._' �6'j y..G L-,:. +��. - f
LOCALITY Cr'.,�,�.""t' ✓ �:...-. e- ,
CONNECTION DATA
NEAREST STATION - DEPTH
URP-ER
CROSS ST.
j MANHOLE REFERENCE ` LOWER
OWNER
TYPE OF CONNECTIONLENGTH FROM
MAIL G. r7 - ,.p s'7 ,Y. CURB P.L. M.L.TO P.L.
ADDRESSV..�.,� -i iZ" C'I�. ri
.: .- c"✓ P.G.NO.
CO.IMP.NO. JOB NO. -
CITY TEL.NO
LEGAL - TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO. ��i+'"/d��
AFFIDAVIT WAIVER EASEMENT RECORD.INSTR,NO. DATE
BLOCK TRACT t� ` ,.✓ , 'r
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF
BUILDINGS STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
CONTRACTOR ;� - -�."� , .1�'r '� WASTE APPROVAL
CHARGES
ADDRESS !y'"f
,c! w� �5)? I CONNECTION CHARGE FEE
CITY
7-c!- �-. TEL.NO. --( ``s'� d
STATE - L LIC. REIMBURSEMENT FEE O
LICENSE NO. CLASS
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE V
HOUSE SEWER CONNECTING TO
PUBLIC SEWERA.. i O
SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWERi`-
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM
SEPTIC TANK.SEEP,PITIS)
CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DRYWELL
EXTN.,CESSPOOL,DRYWELL,MANHOLE
ALTER,REPAIR OR ABANDON HOUSE ALTER.REPAIR,SEWER OR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUGAND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS[J
OWNER'S
Permit 5 SEEP.PIT(S)Q CESSPOOLS J
AUTHORIZATION TOTAL FEE VALIDATION
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIB D EXISTING DWELLING
TOTHE PUBLIC SEWER. _
SIGNED THIS "r' ' DAY OF lL s`. - 19
OWNER OR
OWNERS AGENT ±yl ":`�-..� `-
ADDRESS
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS PPLICATION
_AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY.AND STATE OF
CALIFO.RNIA OR THAT I AM THE LEGAL OWNER OF,A INTEND TO RE-
SILE INTHE ABOVE DESC D SIDE NTIAL PRO RTY.
i 7
SIGNATURE
OF PERMITTEE -"'� � �
A
76A642D
ZE 608(REV.61781
�P)S APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT N0. GROUP I
8K PG MAP PROCESSED BY
BUILDING
ADDRESS �`.L.:.- '-„f`L"LC "G%•.���"I j�°` �:.-.._.., _.
CONNECTION DATA
LOCALITY
NEARESTSTATION DEPTH
CROSS ST. t e s �'�,.' _.s
UFF%R
�.�` MANHOLE REFERENCE , -- - LOWER
OWNER �.1, IC``t -y4 - ,.._ �j :.,.- 4"' 7,
= TYPE OF CONNECTION LENGTH FROM
MAIL ,a ,b Y_ CURB P.L. M.L.TO P.L.
ADDRESS .,.._. �.=-- -Y+i' 0 "" 2.>! -. 3c
P.C.NO.
,r - ,'n1" CO.IMP.NO. JOB NO.
CITY ".` [ Y -TEL.NOd' - 2'y .
LEGAL -y' TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO. _; 'it
( ��_.. Wit=
AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT . .x .,
NO.OF SLOGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF
BUILDINGS STATE ENCROACHMENT
PERMIT NO.
"� 1.1'� '' .+CyE " -.(; INDUSTRIAL
CONTRACTOR
WASTE APPROVAL
ADDRESS A. �"�y''..."._.� b��:.ice:_ ��' {• � CHARGES
CONNECTION CHARGE FEE
CITY "�-�' ' TEL.NO. ':=
STATELIC. REIMBURSEMENT FEE
LICENSE NO. / - CLASS w
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTO1'S SIGNATURE (�
HOUSE SEWER CONNECTING TO
PUBLIC SEWER NEW HOUSE SEWER p �t+ -> O
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG.OR SEPTIC TANK,SEEP,PITIS) z
WORK TO HOUSE SEWER AND/OR DRAINFIELD _
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DRYWELL❑
EXTN.,CESSPOOL,DRYWELL.MANHOLE
ALTER.REPAIR OR ABANDON HOUSE ALTER,REPAIR,SEWER OR
SEWER ORD ISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
OWNER'S
Permit S SEEP,PIT(S)❑ CESSPOOLS
AUTHORIZATION I TOTAL FEE VALIDATION
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
P
SIGNEDTHIS g DAY,{p/{F y' = IOWNEROR9
OWNERSAGENT
ADDRESS --'b ✓"'
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED ASREQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWN'FR OF,�ANND INTEND TO RE-
SIDE IN,THE ABOVE DESGRfOED RESIDENTIAL PI�94PERTY.
SIGNATURE � � 'Y
OF PERMITTEE