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Home My Public Portal About4809 ARDEN DR_Sewer__ A642D 76A6420-63 APPLICATION FOR PERMIT ,,COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL �,,.UEPA&MENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FDD G JOHN A LAMBIE County Engineer S 0 � ) I� WILLIAM A JENSEN Sup t of Building Y T FOR APPLICcANT TO FILL IN BT C Y t -S AL DESCRIGPTI N LOT NO J• /(� OWNER r- ��/ MAIL BL TRACTJ1147 ADDRESS �( 4 ? NO OF BLDGS SIZE OF LOT ' o�-�Jl NOW ON LOT �"'— CITY VC'--J"11 D kl_ TEL NO USE OF DISTRICT NO GROUPMAP PROCE D BY BUILDINGS ) L-� h BK PG CONTRACTOR L r /'n. t \ e V" V �- ADDRESS b CONNECTION DATA CITY r�Ln 04,k 11EL NO }�dl STATION t C— DEPTH REGISTRATION NO LJ CTATE Y MANHOLE REFERENCE J OUNTyt LOWER NO DESCRIPTION OF WORK FEE TYPE OF SON ENGTH FROM / HOUSE SEWER CONNECTING TO Y C� UR P L M L TO P L PUBLIC SEWER E5 00 PC NO d SEPTIC TANK SEEPAGE PIT OR CO IMP NO 3 J JOB NO O PITS AND/OR DRAINFIELD ,- @ S1000 (J HOUSE SEWER CONNECTING TO UNK PERMIT NO PE PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFI 9AStMVkrj RECORD INSTR NO DATE D WORK TO HOUSE SEWER @ E3 00 ) OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE @ $500 HWY ORS WIDENING ABANDON HOUSE SEWER ORPL 5Y EM 33 00 I ^@ N STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S /PERMIT s 2 00 AUTHORIZATION TOTAL FEE C'�. CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS AY OF 19 C, OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE RE D THIS &PPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE O COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM In CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND T RESIDE IN THE ABOV DESC IBED RESIDENTIAL OPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ ' OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH LIL 37861Z SEP 151 0 D 5.00- lsa"�Z-1 76A642DAPPLICATION , F® 1 RM IT 7 6&E'6631254 1 DIVISION OF BUILDING AND SAFETY WE R®SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING WM J FOX COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST LEGAL I y DESCRIPTION LOT NO , OWNER BLOCK19, 11 TRACT MAIL ADDRESS NO OF BLDGS � r SIZE OF LOT !/ X NOW ON LOT CITY TEL NO USE OF i BUILDINGS DISTRICT NOI � GRO� I MAP d�/'1� CONTRACTOR ^� �BK PG -S:7 ADDRESS CONNECTION DATA CITYTEL NO STATION f '�2,$ DEPTH QSTATE MANHOLE REFERENCE REGISTRATION NO l Q COUNTY �V 111mCBSB LOWER TYPE ECTION LENGTH FROM NO DESCRIPTION OF WORK FEE I Y CURB P L M L TO P L - _ HOUSE SEWER CONNECTING TO PUBLIC.SEWER @ $ 3 50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO 'WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING 301 057 _ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT __AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPEfC TANK SEEPAGE PIT OR + PIIS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES I PERMIT CONNECTION CHARGE FEE OWNER'S s 00 AUTHORIZATION TOTAL FEE S'� REIMBURSEMCNT FEE TRACTORHAVE T TOS CONNECTDATE ONTRTHEA ABOVE WDESCR BEDITH THE HEXISTINGEREIN A DWELLING CON APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS DAY OF 19 OWNER OR CONNECT ADDITIONAL OWNERS A NT V BUILDING OR WORK SEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACSXOWLEIGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THA ROVE IS CORRECT AND AGREE TO COMPLY " WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 -AM PROPERLY RErISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR T 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESID TIA PROPERTY BACKFILL SEPTIC TANKS E]SEEP PIT(S) E3CESSPOOLS❑ SIGNATURE OF PERMITTEE ' WILLIAM J FOX COUNTY ENGINEER VALIDATION - - - - `0-3 6 ? FEB 8Y 4 6,5 Q to "� BY -� BY 4 -- DEPUTY DEPUTY ++ BY - - BY ® DEPUTY DEPUTY