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Home My Public Portal About4828 ARDEN DR_Sewer__ G 82 76A642D APPLICATION FOR PERMIT 8A84 OC� COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING b /j �� JOHN A LAMBIE County Engineer ADDRESS L d d tj WILLIAM A JENSEN Sup t of Building L [LOCALITY eynb NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO l OWNER Q m MAIL BLOCK TRACT 9 ADDRESS 2 ple jI7SIZE OF LOT 2ty NOWOON LOTS CITY Q TEL NO USE OF �+ DISTRICT N GROUP MAP PROCESSE B BUILDINGS d �.3 QiY'Q/ BK PG CONTRACTOR ADDRESS CONNECTI N TA CITY NO ON �� DEPT / ❑ STATE MANHOLE REFERENCE REGISTRATION NO ❑ COUNTY C LOWE - d NO DESCRIPTION OF WORK FEE TYPE F C N CT ON LENG7 F P C NROM O HOUSE SEWER CONNECTING TO Y U P L M L P L U PUBLIC SEWER @ $5 00 Q SEPTIC TANK SEEPAGE PIT OR O PITS AND/OR DRAINFIELD @ $1000 .108 NO rO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT O W PRIVATE DISPOSAL SYSTEM @ $300 {LLLLLLLIJJI CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE d WORK TO HOUSE SEWER @ $300 H OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE H R T WIDENING SEWER OR DISPOSAL SYSTEM @ $3 00 S PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER S PERMIT $ AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 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 --dP-DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 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 [IPLUMBING AND SEWERS CESSPOOL ❑ DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ];jVaBEDED/RESIDENTIAL PROPERTYABANDON HOUSE SEWER SIGNATURE OF PERMITTEE (((///lll/JJ y BACKFILL SEPTIC TANKS ❑ SEEP PITS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER L,L,) 7 5 j 6 3 AfIR 10 1 1 D 2 5 00- l IO 63 76A642D APPLICATION FOR PERMIT 6A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION TADDRES�S LDING `� JOHN A LAMBLE County Eng>neei D rz WILLIAM A JENSEN Supt of Building AL TYREST ` Ln It,a�ZjLr6 FOR APPLICANT TO FILL IN55 5T j7 ��111 AI LEGAL DESCRIPTION LOT NO OWNER 1✓ MAIL BLOCK TRA T ADDRESS IfIA NO OF BLDGS 1 -317 SIZE OF L OW ON LOT CITY TEL NO a USE OFDISTRICT NO I GROUP MAP PROCE BY BUILDINGS BK PG t CONTRACTOR ADDRESS CONNECTION ATA CITY TEL N TATION O v DEPTH 1 STATE MANHOLE REFERENCE REGISTRATION NO COUNTY O R NO DESCRIPTION OF WORK FEE TYPE ECTION LENG FROM HOUSE SEWER CONNECTING TO Y Ro P L M L T d PUBLIC SEWER @ $5 00 P C NO O SEPTIC TANK SEEPAGE PIT OR 0 JOB NO PITS AND/OR DRAINFIELD @ S1000 V HOUSE SEWER CONNECTING TO TRUNK P ROAD PERMIT NO. ix PRIVATE DISPOSAL SYSTEM @ $300 0 CONNECT ADDITIONAL BLDG OR AF IDAV IT WAIVER cis EM¢x RECORD INSTJ� NO DA WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD Y.I EXTN CESSPOOL DRYWELL MANHOLE @ SS 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST DINING H SEWER OR DISPOSAL SYSTEM $3 00 ✓ STATE EN O PERMIT O INDUST IAL WASTE PPROVA C A OWNERS PERMIT S 2 00 AUTHORIZATION TOTAL FEE CONN CTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIG ATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES OUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I A THE LEGAL O R OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE E BED AL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PITS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH V�� 7 5 5 7 APR 10 1 0 D 700-