HomeMy Public PortalAbout4819 ARDEN DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER BUILDING
ADDPESS
OR APPLICANT TO FILL IN LOCALITY
ADDREISSBUILDIf NEAREST
j CROSS ST
'I DISTRICT NO SERIAL NO PERMIT NO
LOCALITY �. 7 A S� ��3/L/ J
c
NEAREST r1
CROSS ST
RECEIVE D• Y Ready for Inspection DATE IS
SUED
OWNER , / �,
MAIL �j
ADDRE S f U E ZONE OCCUPANCY MAF{
y� vt BK PG
CITY TEL NO ��5, '—
CONTRACTOR
I CO IMP NO 2�
ADDRESS . JOB NO
CITY TEL NO TRUNK PERMIT NOTATE
_
REGISTRATIO NO H COUNTY{ 2 -767//
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO /y /� /J/ STATE ENCROACHMENT
PERMIT NO
A
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 7,5—, Q NOW ON LOTS CHARGES
NO OF USE OF ��J�j���//1 CONNECTION CHARGE E
BUILDINGS
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S 350 �(� RECEIPT NO ATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR ►1 EXCEPTION REC DED
WORK TO HOUSE SEWER 1 00 (/
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATIONf, 6— DEPTH 6
CESSPOOL—DRYWELL 47
SPECIAL CONDITIONS ONLY 200 / ANHOLE REFERENCE
i� 'URP-ES LOWER
TYPE 0 N ECTION LENGTH FROM
OWNERS PERMIT ; 00 CURB cl?'r ML TO P L 5,[
AUTHORIZATION TOTAL FEE d
CONTRACTORS DATE TO CONNECT THTED E ABOV H THE DESCRIBED EXISTING ED APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS . DAY OF _14 NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGEN
w SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[-] DRYWELL
CA
TIONAND 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS EQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIF NIA OR THAT 1 AM THE LEGAL OWN- -
ER OF THE ABOVE CRIBED RESIDidL
TERTY BACKFILL SEPTIC TANKS
SIGNATURE Tti
/ SEEP PIT(S)� CESSPOOLS
OF PERMITTEE _
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