HomeMy Public PortalAbout9713-9713 1/2-9715 LONGDEN AVE_Sewer__ APPLICATION FOR PERMIT
DIVISION OF BUJLDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX,COUNTY ENGINEER AIDDRESS
CASSATT 0.GRIFFIN,SUP"POF BUILDING LOCALITY �±
FOR APPLICANT TO FILL IN NEAREST
CROSS 8Y.
LEGAL
DESCRIPT10I LOT N0. ✓¢ '` fit � .� `` OWNER;
BLOCK MAPL
ADDRESS '
NO. OF BLDGS,
_SIZE O.F L OTi — - OW ON LOT _CITY ! l �P'v,. TEL. NO.
USi UP w -.
�
BU'Lr)Is GS _I.;. ",. ., DISTRICT N0. or GROUP &IAF
CONaR CTOR
A �,�
L'LR5... d 1. - F .�, —._CONNECTION DATA-- --
CITYTEL. '" STATION
❑ STATE MANHOLE REFERENCE UP ER
REGISTRATION NO
NO. DESCRIPTION OF.WORK FEE ---- ----- ------------_ __—�.-----------
—� '— - -- -- --- TYPE OP --- ECTICN LENGTH FROM �
i HOUSE EW R ;ONNF.CTIN TO « I Y. �' ' P I r: i L. !,� P.;'
_ 1 PUBLIC S AER . S 3 50 ' ------- — .,_ ..__ - ---- -- --
Hous �EVi ER CONNECTING TO
FH VATE G SPOSAL SYSTEM ! OG -------
C
COI N E C T P D D!7 1 OINAL 6U)G OR--�-- �y+. r C. N 0
tIGIt ) F' USE SEWER
ItflP iti?--�.i/_.. ..--
A X13 OR
tE5 _ X -
Er(, Ct D SPOSaL SYSTEM �— -_.t_. 00..aI..�_{
_TRU._NK PERMIT MI.1.
NO. ROAD PERMIT NO./C!,0 0 �
C —ON Ea STATE zNCROACNAEvT GIS F4 D O AL SY T 4
-`- - — PER?AOT r o.
1
SEPTIC T elf. -C£ At'� PL OR ,.>;r ' __,.. ___ -_____—__
_ t' is A D'CR D'' IN>;I:LD - .. 00-iE_ INDUSTRIAL
-- '-- WASTE APPROVAL
_.._
CESSPOOL- DRYSELL
SPFCIAL CONDiTIONS ONLY 2.00
CNN-CT10N CHARGE F':E
OWNER'S PERMIT e� Li 00 _ --
I
it_II17BURSII:MEF I_FEE:
AUTHORIZATIONTOTALFEEi ""
t HIIAVE THIS LATE CO RAC E '00TH THE HEREIN -NAMED
COPS-
TR4L UP "10 dLNvEd1 THE ABOVE DLSChtrcD --- 'RRWC�--A—�®V�AIs 7— D-47"E- NN NSPECTOR eSI�GkAT`UR-XIS N> D E LING
�
r` I "< yi>`„ •ivy, NEW HOUSE SEWER
SIG
ED THIS D:AY OF______� y
OW,LER ,)R t; - t CONNECT ADDITIONAL
0Vvhcr3`, ACEN'1'� t�✓ .. SUILGING CR 1lORK
-- -`---_— -- _-- e—_--- - ------'--
ADDRE .p.Y'3-..— n .S
-.afi EPT/ORIC TA AINFI"P, PIT(S)
Iv Eac
Y ACKNOWLEDGE THAT I HAVE 4 AD THIS AFFLICATiON CESSPOOL DRYINELL.I] -
A D STATE THAT THE ABOVE. S CORRECT AND AGREE TO COMPLY
t^ITH ALL, COUNTY ORDINANCES AND STATE LA'A'S REGULATING
PLUhBING AND SEWERS. ALTER,REPAIR SEWER OR
_
9 HEREBY CERTIFY THAT S AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND Y-- ._d.._.—.__..�-
CADFORNIA OR THAT I AM -,HE LEGAL OWNER OF THE, ABOVE. ABANDOTi HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY, - , BACKFILL SEPTIC TANKS J
SIGNATURE
OF PERMITTE
WILLIAM J.FOX.COUNTY EuGiNErn VALIDATION R.A.WOODCmiEr FL.SG. INSPECTOR
7 -66Y3 3..X35
&2-68APPLICATION FOR PERMIT
1i fk E
DIVISION Of! BUILDING AND SAFETY SEINER-SEWAGE (DISPOSAL
Depcatment of County Engineer
County of Los Angeles BUILDING p / '
WM.J. FOX, COUNTY ENGINEER _ADDRESS
CA$$ATT D.Cs RIFF'IN, Sup>r op BulLnrn� LOCALITY "
z
FOR APPLICANT,T IN _NEAREST
OSS aT r' t
LEGAL C 1 a
DESCRIPTi ON SLOT NO_�I 4 OWNER
y
BLOC TRACT is.. ' .�Y" •,� pp'f'..`;r.. "A'L
r a _ADDRESS
NO. OF BLDGS. ? _"^---
-SIZE OF LOT _ -_, NOW ON LOT - CITY TEL. NO.
USE OF .>✓
SU[LDINGS DISTRICT NO, GROUP i MAP
13K PG
CONTRACTOR �} i ,..':. Wit'...'
ADDRESS 1_ CO15 NECTION DATA
CITY
. -.. } A' STATION DEPTH
_• !- TEL,NO ,�° }
fl
MANHOLE REFERENCE E
__UPPR STATE —
REGISTRATION N0. �' 0_:g�qVATY
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FIROM
�. HOUSE SEINER CONNECTING T4 �y _- -y,�-_—CURE —P_L. M1i,L.-O P.L.
PUBLICSEWER Q.. $ 3,50 -- -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1,00
CONNECT ADDITIONAL BLDG.OR _ ._. T P C Nv.
K ---�--
4VC'RTU HOUSE SEWER 1.60 - �:..�• CO. IMP. NO. .108NO.
ALTER 02 REPAIR EXISTING
SEWER OR DISPOSAL.SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISI,C�NNECT AND ABANDON SEWER STATE LNCRO.ACHMENT
AND/OR DISPOSAL SYS,-EM _ 1.00
PERM IT NO
SEPffc TAF SEEPAGE PIT OR _
PITS AND/ DRAINFI_ELD UO INDUSTRIAL
CEr5POOL D!SYLvELL
----.-- -----'-'---- WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 _ CHARGES
- CONNECTION CHARGE FEE
OVTIbd �S
PERMIT
S t 00 —
AUTHOIZATI0N I T®'TAI. PEI.. ��� REIMBURSEMENT FEE.
I PAVE THIS DATE CONTRACTED V,�ITH THEF ERE N NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE JINSPECTOR'S SIGNATURE
THE PUBLIC SEWER -- - - —-- --
SIGNED THIS DAY OF.— 1'�_ NEW HOUSE SEWER
OWNER ^R CONNECT ADDITIONAL
OVNERS AGENT BUI!DI
OR WORT,
SEPTIC TANK,-SEEP, PIT($)
-A_DR IIEC AND/OR_DRAINFI LD`
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRY,WELL❑ � �<
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR
PLUMBING AND
SEWERS. SELVAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Oft ----"'"'�--- -
LICENSED AS REQUIRED BY LOS A14GELES COUNTY AND STATE OF DISCONNECT PLUG AND W�
CALIFORNIA OR THAT IAM. THE LEGAL OWNE4 OF THE ABOVE ABANDON HOUSESEV/ER
DESCRIBED RESIDENTIAL PROPERTY.- t
BAGiCFIL!SEPTIC TANKS❑
SEEP. PIT($) ❑ CESSPOOLS
SIGNATURE
OF PERMITTtIE'�'' v
WILLIAM J.FOX.COUNTY ENGINEER_ VALIDATION R.A.WOOD.CHIEF PLEG. INSPECTOR
WA
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