HomeMy Public PortalAbout9832 LONGDEN AVE_Sewer__ Ab
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&E•66663 12•Sb APPLICATION FOR PERMIT ],
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DiSPOSAL
Department of County Engineer
County of Los Angeles BUILDING -
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN.SUPT OF BUILDING LOCALITY -
FOR APPLICANT TO FILL IN NEAREST
CR055 5T.
LEGAL _
DESCRIPTION LOT N0� ��� _ OWNER -
BLOCK TRACT MAIL
NO. OF B L D G S. -
SIZE OF L07 �N N06V ONL07y - CITY TEL. NO.
USE OF -
BUILD.INGS s _. ._,. DISTRICT NO. f GROUP ' MAP
SK PG.
CONTRACTOR 11
ADDRESS CONNECTION DATA � -
CITY TEL. NO. STATION - DEPTH
._._._..._._.,._....._. ...� -..._.____-_._._.ad�.,...� STATE --��~.....�•-.,._-,.i-.+...�-Alrt.iiHOLE REFERENCE- -- - ---
REGISTRATION NO. COUNTY _ LIPPER
-.. TYPE OF CONNECTION ..w LENGTH FROM -�..- --
NO. I DESCRIPTION OF NVORK FEE �U9t3 R,L TOP,
_L.
HOUSr SEVER CONNECTING TO .
1 PUBLICS WE_R $ 3.50 --
-"�� HOUSE StW ER CONNECTING To
Pjjj1vAI
CONNECT
DISPOSAL SYSTEM 1.00 .�B.NO. ----
-
CONNECT A USE SEWER BLDG. OR { CO. IMP.F!0 - JOB. NO.
WORK'CO HOUSE SEWER 1.04 .' { '- _ _
~—I A LTER OR REPAIR EXISTING
S£4ti t:R OR DISPOSAL SYSTEM _ 1.00V ( TRUNK PERMIT NO. ROAD PERMIT NO
DI CONNECT AND ABANDON.SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM Y`00_I PERMIT NO.
EY !C TANK,SEEPAG PIT OR
PITS kDlD/ort DRAINFt I.D 2.00 I - INDUSTRIAL
l_
. WASTE APPROVAL
CESSPOOL DRYWELL -
PECIAL CONDITIONS ONLY 2.00 ! - CHARGES
- T CONNECTION CHARGE FEE
OWNER'S PERMIT_ � t 00
AUTHORIZATION TOTAL �` EREiMBURSEMENT FEE
I HAVE T,'IS DATE CONTRACTED WITH THE HEREIN I4Ad1ED CON- INSPECTORSSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DArL _. CTOR'S _
TO THE PUBLIC SEWER - --- -�
NEW HOUSE SEWER
SIGNED THIS— —..DA.Y OF—.-19-
OWNER
F - . 1S___.
OWNER OR CONNECT ADDITIONAL — --
OWNERS AGENT nUILDING OR WORK�
SEPTIC TANK, SEEP,PITS)
ADDRESS—..�. __ _ AND.%OR DRAINPIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL El DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT' AND AGREE TO COMPLY _ -------
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER., REPAIR,.SEWER OR
PLUMBING AND SEWERS. SELVAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT. I AM PROPERLY REGISTERED AND/OR `"-�"�•�`- ��—
LICENSED AS,REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND if
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. -BACKFILL SEPTIC TANKS[I
- - SEEP.PITS) CESSPOOLS _
SIGNATURE -
OF PERMITTEE
WILLIAM J. FOX,COUNTY ENGINEER. VALIDATION yy g
BY iv,-6 BY
DEPUTY Dr, r
BY BY
UY DEPUTY DEPUTY