HomeMy Public PortalAbout9722 LONGDEN AVE_Sewer__ 6AE-66 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEINER—SEWAIGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDIPIG .- _ - �
WM.J. FOe , COUNTY ENGINEER ADDRESS !
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CASSATT D.GRIFFIN,SUPT oto BUILDING
LOCALITY
FOR APPLICANT TO FILL pig ^NEAPES7 a� �J
_gym CROSS ST. .ro :_-. ,,"^_,, `;i
LEGAL. J �,F.., ~' c" _� -
DESCRIPTIOPd---LOT Nt +�•4— "` 4srAt, o�3" /" OWNER �>' �, Y .:yam• yt' u �
BLOCK RACMAIL
AviT � § 14' 6464 'A11RES51 +� ."'.
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NO. OF BLDGS. `• c„
7E OF LOT NOW ON LOT ,i- _ CITYLy
Si /�..E- < . L. NO. `
USE OF _°" ``�
BUILDINGS DISTRICT NO, GROUP MAP
EK PG
CONTRACTOR
ADDRESS ,d 4 ,� /� P' te JCONNECTION DATA
CITY —.l= d TCL. NO. ..,�,� '�.J y"„��,� _ _STATION g'� Mid ��DEPTH
_ e '. _ 40 _
STATE MANHOLE REF€RENCE —
UPPER
REGISTRATION NO. % ' r.s+' L' L COUNTY
NO
DESCRIPTION OF WORK FEE -- -- ------ ---
TYPF" ---
,4 MOUSE EV1 ER COP N 1NG TO aF_1taWNF.CTILENGTH FROM
.ON
( Y. F CURB p P.L. M L. P L; �+v,•:.,,,
f PUCiLIC SEI:�'R _�ct S 3.50{.— _. Z L} -.- -----
I HOUSE SE'-MER CONNECTING TO I1
_ PNiVATE DISPOSAL SYSTFM 1.00
CONNECT HOUSES AL BLDG. OR CO, IP�!P. NO, POB NO ;
d —�
WOK1C TO HOUSE SEWER 1.00 d - E-
el3 f
ALTER OR REPAIR EXISTING —'�—�`-- .--- --- =yL
_!
SEWER OR DISPOSAL OSAL SY TEM 1.00 I TRUNK PERMIT NO ROAD PERMIT NO._/,'f' ��
T�
DISCONNECT AND ABANDON SEWER I STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM _1.00 pER14IT NO,
SEPTIC TANK, SEEPAGE PIT OR — --- --_.. ---"—."—"— ""'�---'----'--- - '—"--j
P1 5 ANG OP DRAINFIEID ,00 I INDUSTRIAL
CESSPOOL
`
CWASTE APPROVAL
�SSpOOL DRYJ4EL.L =�--->— 1
SPECIA CONDITIONS ONLY 2-10 CHARGES
---• -- --- - CONNECTION CHARGE FEE
OVMEWS
IOIAY, ---
r—
AUTHORIZATION FEE �( 9 REIMBURSEMENT FEE
-
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- �y9fT��+w-�
TRACTOR TO CONNECT HE ABOVE DESCRIBED EXISTING Det LLING APPROVALS DATE IivSF€'YOB'S SIGNATURE
TO THE PUBLIC EWER g.Y,.
SIGNED Tt3lS r nAY OF �.- Ia NEW HOUSE SEWER - -- --
OWNER OR --?T` CONNECT ADDITIONAL `:_.-,_ ._
� ' UILDING OR WORK
'IN ttt
ON E R S A G E N TT mss:'A-i1 -B------- - `— ---j"'--- ----'-
�, SEPTIC'i'ANK, SEEP PIT(S) 11
ADDRcSS`"� AND/OR DRAIN F(E_LD
—r --
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION f CESSPOOL 0 DRYWELL[f
�_-i---- -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WIT}I ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR SEWER OR
PLU iBING ANC SEWERS. SEWAGE DISPOSAL SYSTEM i
I HERE 3Y CERTIFY T14AT I D.Pd PROPERLY REGISTERED AND/OR ---'- --- -"'-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND a
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER -_
I1€SCR BED RESIDENTIAL PROPERTY y r :F ' --
BACKFILL SEPTIC) TANKS u i.
I SEEP PIT S) CESSPOOLS
SIGNATURE -'�:•-
OF PERMITTEc
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION E2,A.WOOD, CHIEF PLBG. INSPECTOR