HomeMy Public PortalAbout9834 LONGDEN AVE_Sewer__ E808 10-63
5A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE;DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDREBs `
evILDING '`a
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Sunt of BuildingLOCALITY
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NEAREST
FOR APPLICANT TO FILL IN CROSS S7
ALGAL
DESCRIPTION LOT NO >t _ OWNER
BLOCK TRACT T' T J �� JIf ADDRESS y
NO. OP BLOCS.
SIZE OF LOT ON L07_. '""y CITY TEL. NO.
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ADDRESS CONNECTION DATA
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-.— ..+" ,�, -e'" d' STATION - DEPTH
CITY '.`.P"., .jG y_ T Et N O.. ,".' Tf 3 /._-..>-- _. -_
ATE MANHOLE REFERENCE a UNPER
_. ___
REGISTRATION NO. COUNTY _
NO.-�� CESCRIPTlON OF WORK FEE
TYPEOP CONNECTION LENGTH PROM
�i
HOUSE SEWER CONNECTING TO--- -- -- Y +tL RB P L M.L,TO P.L.
- PUBLIC.SEWER � $5.G0 ' �"�—'
SEPTIC TANK .SEEPAGE PI7 OR�__-_.__ .^ eE.'� ,f-_-. . '�. P C.NO.
- JOB NO
PIIS AND/CR DRAINF'ELD @ $10.00 --� CO IMP NO,
t HOUSE$ WE CYJNNECYMNG PRIVATE�tSTRUNK PERMIT NO. ROAD PERMIT NO.
T PO A.I_SYSTEM $3.UU '0
_ _ __ __ ___y._—__—.-
C
CONNECT ADD TIDNAL BLDG OR _ 5FIDAdIT WAIVER';EASEMENT RECORD.INSTR NO. DATE
WORK TO iV J5E SEWER @ $3.00 ,,. -�,P'.9 - T I
-LOW SEEPAGE PIT,GRAINFIELD
EXTN 'ESSPOOL DRYW ELL,.MANHOLE @ -
ALIEK,JRE'.AIR OR ABANDON HOUSE $�_,U0--. HWY. OR ST.WIDENING SEWER OR D SPOSAL SYSTEM ^ $3.Of3 STATE ENCROACHMENT
PERMIT N.O. .--�
INDUSTRIAL
I WASTE APPROVAL._
CHARGES
OwNurs PERMITz! 00
CONNECTiONydHARGE FEE.
AUTHORIZATION TOTAL FEE S -- ------- _-_-- ---____--
-1 HAVE AT T'HiS DATE A CO=NTRACT WITH THE HEREN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - -- C -------- _�
O -
. .HE UB'-C SEWER. APPROVALS DATE I INSPECTOR S'SIGNATURE
SIGNED i'HI5-----DAY OF---19--
OWNER
F_^ 1g--OWNS OR NEW HOUSE SEWER �
OWNERS AGENT.____--_.,.___�--___.__�---.—._
CONNECT ADDITIONAL ,I
BUILDING OR WORK 1 -
ADDRE S -___ SEPTIC TANK,SEEP PIT(S)
I HFREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND!OIR DR.A!NF'IELD
AND S AT THAT TH.. ABOVE IS CORRECT AND AGREE TO COMPLY --.-.---:-- - - - - - --------� --- --------
WIT
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ALL. C 0 U N ! 0RDI NAN E AND STATE LAWS REGULATING
r,L U MING AND SEWERS. CESSPOOL ❑ DRYWEI_L
1 HEREBY CERTIFY THAT I AM PROPER'Y REGISTERED AND/OR ALTER.REPAIR,SEWER OR
L i CENSER AS REQUIRED BY LOS AN'Gy ES OUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
ALIA R;FORNOTHAT I AM H'E'. E,AL. O .y@Y ,ER OF, ND INTEND TO pISCCNNECT FLUE AND--�
RE5'DE IN, THE ABOVE BED�R,` NTiA- ROPE RTY.
ABANDON H31JSE SEWER -
SIGNATURE _ ,�✓ BACKFILL SEPTIC TANKS ❑
OE' PERMITTEE '�-�'._ �' ❑
_ ------_—_- SEEP.PIT(S) [,� CESSPOOLS
-µ--VALIDATION ROBERT A. WOOD
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SCK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
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