HomeMy Public PortalAbout9815 LONGDEN AVE_Sewer__ (�l DEPARTMENT OF COUNTY ENGINEER SFgWER—SEWAGE DISPOSAL
' DIVISION OF BUILDING AND SAFETY ,r PERMIT APPLICATION
_ COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER `j�°V �I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY _ 00�i
BUILDING ��� l NEAREST G�
ADDRESS � ��/� {� CROSS ST.
LOCALITY� y DISTRICT NO. SERIAL NO. PERMIT NO.
Oda"NEAREST _ �- J $
CROSS ST. , �,,�� �.._ ;.� REC VE B,Y Ready for Inspection D E 1 ESD!
OWNER
MAIL w USE ZO OCCUPANCY MAP
AD�DyRES�S -�_j� � ��: T�j���-E77-./U /BK PG
,rJ.nif.-. �r,'P'%TEL.NO. l'7�%s':� P1.� / � � `- '7 Z
CONTRACTOR
CO.IMP.N0.
ADDRESS
_S:49 y I JOB.NO.
CITY r TEL.NO. • 1 TRUNK PERMIT NO.
STATE ,
REGISTRATION N0. Q B COUNTY ROAD PERMIT N0.
DESCRIPTION LOT N0`�J90>�'E'/o0> 6r/ /' PERMIT NCROACHMENTO.
,
BLOCK TRACT�A�rA���f�/A�/n ATSEPWSTRIAL
AL
SIZE OF LOT NO.OF BLOGS. . ' CHAR
y /r jly NOW ON LOT +�Y
USE OF 7r7Z Yxr'/+V s CONNECTION CHARGE E
BUILDINGS �s r3i r"t_+V 9
NO. DESCRIPTION OF WORK FEE REIMBURSEMEN7'FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.00 RECEIPT NO. 11A EI BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORD
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING Nc, I DATE `
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION > el.. tV DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / �i MANH�OLLEE REFERENCE LOWER
!v YPE OF CONNECTION LENGTH FROM � p
Y. 63f$- -ea-- M.L.TO P.L. O
OWNERS. PERMIT $ I 1 00: �.�AMA
AUTHORIZATION TOTAL FEE ' 09 op /SEr rf/ To 5;:5-fw0
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED,
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING' APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.__.___DA _19� NEW HOUSE SEWER -��,
OWNER OR ! CONNECT ADDITIONAL v -
OWNERS AGENT-__. .._ -C�� BUILDING OR WORK
_..
v SEPTIC TANK,SEEP.PIT(S)
ADDRESS.......... ....... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLI- CESSPOOL I] DRYWELL E]
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. I SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)0 CESSPOOLS
`' '
OF PERMITTEE. _..
7GA642A 663 7/53 A-l/