HomeMy Public PortalAbout9811 LONGDEN AVE_Sewer__ 6A642a0-63 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL �
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION [7ADDRESS
JOHN A. LAMBIE, County EngineexWILLIAM A. JENSEN, Supt of Building $— __ ' -ar•"�-`.FJe✓ y E J;i�a___�.'�xL'.Y .._. .._- ____
NEAREST
FOR APPLICANT OT PID yTOO FILL IN z � CRO55 OWNER
IGAL ,'
!s s P r iwt{,r
oEscRIPT ION --
.- i AD
BLOCK ✓ R'CTA
� LJ 'jam_-- D
_ -- *h0. OF BtDG. .
S12£ OF LOT NOW ON LOT CITY TEA.. NO.
USE OF DISTRICT NO. GROUP MAP PRQ�ESSED BY
BUILDINGS BK PG
ADDRESS CONNECTION DATA
�S �;r �`3 d5 tip p'I STATIbN j' `6� DEPTH
CIT_ _ ..yi -TEL NO � �"' UPPER
MAIC;-1()LE REFERENCE ��4s d
O NTY
�,_. �. ..
REGISTRATION NO .. ax'` / lJ __ ____—� y ,c �'�✓.d __._._ '—tC/t'CEk�`
NO._I DESCMPTION OF WOR FEE _ -.,Rid TYPE OF CONNECTION LENGTH FROM 5f
HOUSE SEWER CONNECFING Y CURB F,L. M.L.TO P.L.
i PUEI 1c SEWER @ $5.00 f P C NO.
_TAN __..-- _PIT
_
5 P7;C TANK,SEEPAGE PiT OF? CO>IMP NO. � JOB NO
I PITS AND/OR DRA.INFIELD @' „10..00. -- _ ______ _.__-- ___-__ —. dj
-IOU SE iv R rONN CTING TO TRUNK PER)KIT NO ROAD PERMIT NOr
S.�!- J.. r '"✓
FR VAI£DI PC5A.L SYSTEM Cs $3:00 _ _ � _ Wq�
—� ONNk;T AOD F.CFAL BLDG OR * — AFFIDAVIT wAIYER FaSE!P.FNi Y RECORD.INS R NO.
WORK TO HOUSE USE SEW E 2. @ $3.00
.—
__. _..
fi OVCR}I..OW S£EPA E PIT bNAtNFIELD I LU
I EXTN CESSPOOL.ORYWELL,M ANH OLE @ $5.00
-- ----------- --- ---- ---- i----- HWY.OR ST.WIDENING
�4LTER.REPAIR OR.ABANDON HOJUl SE
SEWER.OR,DISPOSAL SYSTEM @ $3.OG --___. _._.__ ____.-__ z
4T__ ENCROACHMENT
FERMI'r NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
�g�O,gW�'NgER'S PERMIT_ $ z' 00___ .-._------ --- -----
Agi ALYORIZATI®N TOTAL FEE — — — CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -- 7y p/� T--TO THF PURL C F,WFR. _— APPROVALS_�_� DATE FNSPECTOR S 51GNATU RE -
51 G N E D T H IS DAY
OWNER OR (k� F>r .�--'- NEW HOUSE SEWER j _
OWNERS AGENT - 77
CONNECT ADDITIONAL V
ADDRESS BUILDING OR WORK
. __—
SEPTIC.TANK.,SEEP,Pt'1'(S) -
I HEREBY ACKNOWLEDGE THAT F HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE: THAT THE ,.BO VF: IS. CORRECT AND AGREE TO COMPLY' -- ----- --1--- —
WIT,HALL COUNTY ORDINANCES AND STATE LAWS REGULATING
FLU MBING AND SEW SRS. CESSPOOL I_1 DRYWELL �] ;
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER. REPAIR SEWER OR.
LICENSED AS REQUIRED BY I OS ANGLES COUNTY AND STATE OF .SEWAGE DI.SFOSAL SYSTEM —
CALIF'OR'NfA OR THAT I AM THS'.LEO UWNER LO AND J- TEND TO DISCONNECT ---_---
n ..yyg :R D.15CON NEC7 PLJG .AND
RESIDE IN. THE. A30Yy,,�€ Kt�t'B ED'RES!j3ENT ryi:��'PROP.�R7Y. ABANDON HOUSE SEWER
SIGNATURE 'aterk /P'y y"' � BAC.KF,s..L 5E PTIC TANKS
OF FF_RMIT7EE SEEP,PIT(S) ❑ CESSPOOLS �I
' ""V,ALIDATION ROBERT A. WOOD
CIZM.O. CASH
SUPERVISING 1AECHANIC:.AL ENGINEER
.. �
Lj 17
d