HomeMy Public PortalAbout4842 ARDEN DR_Sewer__ 76,f-66 _ APPLICATION
TOR- PERMIT'. .. -
S&x,:663 11.55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE. DISPOSE►L
Department of CountyEngineer ,
County of:Los Angeles BUILDING
-:JOHN A. LAMBIE, COUNTY ENGINEER. ., ADDRESS
® CASSATT D. GRIFFIN. SUPT OF'BUILDING LOCALITYADMIMM Film
f - • � '
FOR -APPLICANT TO FILL IN
NEAREST
CROSS -
LEGAL - ,OWNER
DESCRIPTION LOT No. - -
001
�j -� -MAILJA� ,
BLOCK•TRACT- •/ O ADDRES - U
NO. OF BLDGS. CITY. ' TEL. N0.
SIZE•OF.LOT.' NOW ON LOT " " :v/✓� C/ - '
USE OF
- •.G OUP' MAP
BUILDINGS N BK PG
CONTRACTOR
ADpRB'ss;' "p / CONNECTION DATA'
CITY .TEL.'N0. � - STATION {� 7/77 DEPTH -
MANHOLE REFERENCE °.. _ UPPER
7 NATE 4' LOWER
REGISTRATION.NCC `D,1;�' ?� El COUNTY - '
NO. - DESCRIPTION OF WORK` FEE
HOUSE SEWER'CONNECTINGTO TYPE OF. CONNECTION- .LENGTH FROM
" Y. CURB P.L. - M.L. TO P.L.
PUBLIC SEWER � @.'$3.50 � _
SEPTIC TANK,SEEPAGE PIT OR - � •" � -
PITS"ANP/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE.PIT, DRAINFIELD P. NO. -
. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. N0. JOB-NO ,
HOUSE SEWER'CONNECTING TO, - � -
PRIVATE DISPOSAL SYSTEM _ @.$1.00 - TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMEN
WORK TO HOUSE SEWER " ' @ $1.00 (/� PERMIT NO. �•--�'✓ '
_-ALTER,REPAIR.OR ABANDON HOUSE. INDUSTRIAL
SEWER OR.DISPOSAL SYSTEM.. .@ $1.00 WASTE APPROVA (( -
CHARGES
CONNECTION CHARGE.FEE
OWNERS PERMITg 1 00 -
AUTHORIZATION TOTAi.FEE a REIMBURSEMENT FEE -
:I HAVE"AT THIS DATE'A CONTRACT W,ITH'THE HEREIN NAMED CON- APPROVALS ,. •DATE- INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -
TO THE PUBLIC SEWER. - - NEW HOUSE SEWER..:
SIGNED THIS DAY OF 19 CONNECT ADDITIONALq.
OWNER- OR BUILDING OR WORK 7 ..
OWNERS AGENT , 1 �'••��! SEPTIC TANK,SEEP, PIT(S) -
'ADDRESS - AND/OR DRAINFIELD
--
1 HEREBY*ACKNOWLEDGE THAT 'I'HAVE READ THIS APPLICATION CESSPOOL❑ DRYW.ELL❑' '
AND-STATE"THAT THE ABOVE IS CORRECT AND AGREETO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS .REGULATING- ALTER,REPAIR,SEWER OR -
PLUMBING AND SEWERS. - SEWAGE'DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I 'AM" PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
,LICENSED AS REQUIRED BY LOS ANGELES-.COUNTY AND STATE OF ABANDON HOUSE SEWER J.
CALIFORNIA:AR.'THAT 1 AM THE LEGAL. OWNER: OF THE ABOVE -
- DESCRIBED RESIDENTIAL PROPERT). ! BACKFILLSEPTIOTANKS❑ - -
SIGNATURE. - SEEP,BITS) (] CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE', COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
. CK. Id.0' - CASH i ..
1.' X0..2, 91cO FEB 21 4 A �:0 0- .M