HomeMy Public PortalAbout9824 LONGDEN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SELVAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNT' OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST --
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. Ready for Inspection f PERMIT N0.
S
NEAREST
CROSS ST
--� -u•- - x �--_� RECEIVED BY DATE I ISSUED BY• DATE
OWNER
MAIL USE ZONEOCCUPANCY MAP
ADDRESS BK PG
CITY TEL.NO.
CONTRACTOR CO.IMP.N0.
ADDRESS -
��.� JOB.NO.
CITY" TEL NO, ;
TRUNK PERMIT NO.
STATE
REGISTRATWN Id C. COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT
NO. _ PERMIT NO.
BLOCK TRACT INDUSTRIAL
_- WASTE APPROVAL
SIZE OF LOT NO.OF BLOCS. CHARGES
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO.I DESCRIPTION OF WORK FEE
_I REIMBURSEMENT FEE
(HOUSE SEWER CONNECTING TO
PUBLIC SEWER_ a $ 3.50 I 1 RECEIPT NO. DATE �BY
HO1tSE SEiYER CONNECTING TO [`
PRIVATE DISPOSAL SYSTEM 1.08
CONNECT ADDITIONAL BLDG,OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0.
ALTER OR REPAIR EXISTING
— DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
A D/Ofl o SPff OSAnLAs STEM SEWER 1.00 _ CONNECTION DATA
SEPTIC TANK.SEEPAGE Pi'TOn
PITS AND/OR ORAINFIELD 2.00 STATION DEPTH
e CESSPOOL—DRYWELL '_�__._.�
SPECIAL CONDITIONS ONLY 2.08 MANIHPOPLEERREFERENCE L F EP
uR
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ L 1 OD CURB _P.L__ M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
7 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.._.._._. .--._._DAY OF... NEW HOUSE SEWER i
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.., ,. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS _ d ........< ... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLI- CESSPOOL Q DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I Ali! THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Q
SIGNATURE SEEP.P)T(S)El CESSPOOL$0
OF PERMITTEE: w c. c
76A542D 6&E 663 4/54