HomeMy Public PortalAbout9829 LONGDEN AVE_Sewer__ -5&E-663 12-54 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department cf County Engineer
County of Los Angeles BUILDING r' >'`
ADDRESS
WM.J. FOX, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY-
FOR
OCALI'tTYFOR APPLICANT TO FILL IN NEAR sT
�RO55
ST,,
LEGAL `cyb a>.a`." r :'. .r• _'
DESCRIPTION LOT�NUS- ��� OWNER
BLOCK TRACT i �` ,:�........� MAIL
. •'dam i s >. Z_-7
"'j;d ADDRESS
N0. OF BLDCS.
_. _
S_fYE OF LOT -- ra NOW ON LOT CITY TEL. N0,
USE OFBU
_I2L H=�..ti 1s. _ — ._.,. . T D1aTRICT NO. GROUP MAP
> BK PC
^CONTRACTOR
ADDRESS 's ,. '' I _ �` `t _ CONNECTION DATA
CITY TEL. NO - ,p, STATION r _ DEPTH
C, STATE , MANHOLE REFERENCE _
REGISTRATION NO, )+~ ❑ COUNTY UPPER LvdrdER
TYPE OF CONNECTION LENGTH FROM --
Na. DESCRIPTION OF WORK FEE CURB —ftem M.L. a P_I?.. rte„
HOUSE SEWER CONNECTING TO �� ,
PUBLIC SEWER_ __ �? $ 3.50 u ,
HOUSE SEWER CONNECTING TO
—.,—PRIVATE.DISPOSAL$ STE"rS__— f ..—.--
CONNECT ADDITIONAL. BLDG. OR -- { 7 i ����"" CO, 1MP. NO JOB. NO.
- I ORK TO HOUSE SEWER_ 1.00ALTER OR UA(R tXl TING
_
'EWER Of', DISPOSAL SYSTEM 1.;d0 TRUNK PERMIT NO, ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER
AND/OR fSPOSAL SYSTEM r,OC. STATE ENCROACHMENT
_ ..-- --- -------- - EMIT NO. _
SEPTIC TANK, SEEPAGE PIT OR —_.I-.
PdTS AND/OR DRAiNFIELD 2.00 ! INDUSTRIAL P
-.'�.. WASTE APPROVAL
C� SPOOL DRYWc L
N CIAl CONDITIONS ONLY 2 00 I 4 CHARGES--
'-- -- CONNECT;ON CHARGE FEE
OWNER'S
PERMIT S 00
�- - — ------—-�,..-----
�---�i _... .
AUTHORIZATION TOTAL FEE i RFIMBURSEMENT FEE_
?
HAVE THIS DATE CONTRACTED WITH THE HERFIN NAMED CON-
4
ON- APPROVALS 1
4RFACTOR TO CONNECT THE ABOVE OESCRIB�D EXISTING DWELLING DATE � 1NSPEGIOR*S SIGNATURE
TO THE PUSL C SE1hE :.! .✓'". — _ _ _-
` NEW HOUSE SEWER,
S;GNED THIS ' SAY OF f > - 19 � � —._.--
OWNER• 1'- - rr e�> = _
OWNER OR ,�" J CONNECT
S A''EN ";,�• �, y - 7°'� ;" r"., f µj HUILDING ORNIORK_
SEPTIC TANK SEEP, PIT(S)
ADDRESS._ _AND/OR DR,Y3NFIELD
I HERE6Y ACKNOWLEDGE THAT I`HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL O
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLU14SING AND SEWERS.
SEWAGE DISPOSAL SYSTEM_
i HERCSY CERTIFY THAT I AM PROPERLY REGISTERED ANDiOR --
L!CE:NSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CA L.IFORNIA OR THAT I AM THE LEGAL 01,41NER OFTIE, ABOVE ABANDON HOUSE- SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[]
.. SSFP.PIT(S) 0 CESSPOOLS
SIGNATURE
OF PERMiTYEE
WILLIAM J.FOX,COUNTY ENGINGBR VALIDATION
By
BY f
DEPUTY DEPUTY .
BY BY
DEPUTY .�y,.•:`- l f - DEPUTY
76A 642.-CE808-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FCROSSISST.e'
�
/ J
FOR APPLICANT TO FILL IN
LEGAL .y/ )
DESCRIPTION LOT NO. _ - __.---_ - __- OWNER �� /� R/
MAIL YYY G
BLOCK TRACT ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY 4(./.C_e's 16 —4 TEL. NO of q�/rs
USE OF
BUILDINGS DISTRICT NO.1 GROUP MAP PROCESSED BY
SK
CONTRACTORS/'. I �. !i ` r {:) l' /—,
ADDRESS _�, _ . U 1 tz-: CONNECTION DATA
CITY - 1 tV � TEL. NO. STATION DEPTH
.s 1
STATELIC ,e (/ UPPER
MANHOLE REFERENCE % -� yrJ�j'
LICENSE NO: GLASS
NO. 1 DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTIFROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $7.00
P.C.NO.
SEPTIC TANK.SEEPAGE PIT OR JOB NO.
PITS AND/OR DRAINFIELD � $10.00 CO.IMP,NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER CASEMENT RECORD.INSTR.NO. DATE 'J
WORK TO HOUSE SEWER $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD IY
EXTN..CESSPOOL.DRYWELL, @ $5.00 O
HWY.OR ST.WIDENING
p .y�lY�l#��ABANDON HOUSE l
SEWER SYSTEM @ $3.00 ^_ - STATE ENCROACHMENT ' ui
R� V
MANHOLE $7PERMIT NO. S.'L
.00 —
---- "--- — INDUSTRIAL N
�q, Z
WASTE APPROVAL �,;. '.,,. Oc.,-J's
OWNERS PERMIT 3 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATIONI TOTAL FEE tq
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF/' 19_ --
OWNER OR ' y !
7 "Tvt d/ /9� )s` d NEW HOUSE SEWER
OWNERS AG'E7JT
CONNECT ADDITIONAL
- y
ADDRESSBUILDING OR WORK
�R µ•'I,J L 4 1 Y• R� SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL Cl DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REODURER BY LOS ANGLES COUNTY ))ND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA.,.BR-THAT 1 A THE L —.L OWNER,OF, AND INTEND TO .q
DISCONNECT PLUG AND �Y� �_-
RESIDE IN; THE ABOVE/ ESCRIB RESID NT LyROPE RTY. ABANDON HOUSE SEWER
SIGNATURE \ `�_. BACKFILL SEPTIC TANKS ❑ ','�
OF PERMTTTE -
SEEP.PIT(S) ❑ CESSPOOLS ❑
VALIDATION CK. M.0. CASK