HomeMy Public PortalAbout9705 LONGDEN AVE_Sewer__ 76A642D
CEBOB IREV.6,79' APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP BK MAP PROCESSED BY
PG �
BUILDING
14 ADDRESS �:+C"!r�� �`�C c, g. .
02 J/ ,y CONNECTION DATA
LOCALITY L -/ !&. i � w
NEAREST /, STATION DEPTH
CROSS ST, f- 1 tlf.y�
UPPER
/ {yup MANHOLE REFERENCE
OWNER !>, ly:�.�... J+'C-L' 1.L�' LOWER
r Y � � TYPE OF CONNECTION LENGTH FROM
MAIL C ++. ..�yM.L.TO P.L.
ADDRESSam' y�/' �y. Y` CURB P.L.
/ P.C.NO.
—"� ✓' CO.IMP.NO. JOB NO.
CITYTEL NO. Le '- -.c:�.
LEGAL ,+ - w-r TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO.
AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF
BUILDINGS STATE ENCROACHMENT
tt PERMIT NO.
CONTRACTOR -. i ".� �. �� INDUSTRIAL
WASTE APPROVAL
ADDRESS -` � i'- - J L'�Cr,'' `„_' jri�.v CHARGES
CONNECTION CHARGE FEE
"`
CITY TEL.NO
STATEJ LIC. �-} E' REIMBURSEMENT FEE
LICENSE NO. f CLASS } /
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE
v
HOUSE SEWER CONNECTING TO _
PUBLIC SEWER
NEW HOUSE SEWER
SEPTIC TANK,SEEPAGE PIT OR "'.;. ,i.- -•- �.�,�.,;,,_
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM SEPTIC TANK,SEEP,PIT(S) N
CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD
WORK TO HOUSE SEWER Z
z
OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL [IDRYWELL El
EXTN.,CESSPOOL,D RYWELL,MANHOLE
ALTER,REPAIR OR ABANDON HOUSE ALTER,REPAIR,SEWER OR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
OWNER'S Permit s
SEEP,PIT(5)❑ 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.
SIGNED THIS -; 'X if---- igC
OWNERORJ.. '
OWNERS AGENT >F^-'
ADDRESS -_.1`.r 2>4:L
I HEREBY ACKNOWLEDGE THAT I 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 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER Oii{{ AN INTEND TO RE-
SIDE IN,THE ABOVE DESCRIBEDR! PROP s Y.
f
SIGNATURE
OF PERMITTEE
i
- � � �-fir" _`_ .t f.i�•-.
y
76Atd2D
:,E808:REV..6/78i APPLICATION FOR PERMIT
APs
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP BK PG MAP PROCESSED BY
C
BUILDING�'' Jf''��f ,
AD D R E55'.' G'G'f 6. �,G.: 'y'',•�-' ..
CONNECTION DATA
LOCALITY
NEAREST ) STATION DEPTH
CROSS ST. /i..-�."„ - In
MANHOLE REFERENCE ! .. LOWER
OWNER i� e �`yCIf 1:.r
ROM
MAIL TYPE OF CONNECTION LENGTH L.TO p L.
ADDRESS '!Ji L..t p^ `Q`._�C'l( ! �.. �' `' / J' .. CURB P.L.
7l P.C.NO.
CO.IMP.NO. JOB NO. l �-
CITY C.-> TEL.NO.
LEGAL J "' _ TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO.
,,,� AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE
BLOCK TRACT -,Nef -4' K
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF
BUILDINGS STATE ENCROACHMENT
..,CC .y PERMIT NO.
INDUSTRIAL
CONTRACTOR Z ._T l.-- �" ,�!'r''`ei
_ -'6-�'� WASTE APPROVAL
ADDRESS,f;-
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`
CITY C.' /t-� j°+": CHARGES
-�:S + s TEL.NNO.0 CONNECTION CHARGE FEE
,. , z�-..�� �- �,.�..
STATE y"1 a--
> LIC. ; REIMBURSEMENT FEE
LICENSE NO. L- I') Com - CLASS
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE (,
HOUSE SEWER CONNECTING TO a'
PUBLIC SEWER //
C
SEPTIC TANK.SEEPAGE PIT OR NEW HOUSE SEWERy -, t:ks''--<< {.,
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL y
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM
SEPTIC TANK,SEEP,PIT(S)
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER AND/OR DRAINFIELD _
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL [IDRYWELL❑
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
PIT(S)HEREIN CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTELL
TO THE PUBLIC SEWER.
SIGNEDTHIS "- '' DAY OF " 19
OWNERS AGENT JJ- - � 'E
ADDRESS ��1 .:� L+' - t"
1 HEREBY ACKNOWLEDGE THAT I HAVE READ HIATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGROMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWSLATING
PLUMBING AND SEWERS.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY TINGTE OF
CALIFORNIA OR THAT I AM E LEGAL OWNER,OF, D TO RE-
SIDE IN.THE ABOVE DESGRE =!IIDFNT1Alt:P PEERSIGNATURE
OF PERMITTEE