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HomeMy Public PortalAbout4901 ARDEN DR_Sewer__ CEBOB 10_82 APPLICATION FOR PERMI. 78A 642D / COUNTY OF LOS ANGELES $EWER- E S DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ] JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY <�, NEAREST FOR APPLICANT TO FILL IN- CROSS 5T. LEGAL DESCRIPTION _ LOT NO. OWNER MAIL r BLOCK TRACT •// ADDRESS �.. NO. OF BLDG SIZE OF LOT NOW ON L CITY .' TEL. NO. USE OF w BUILDINGS � DISTRICT NO.%R P MAP �ESE / BK PG CONTRACTOR ._ ADDRESS /74:20 13j{ V� CONNECTIONAT . CITYT . NO. ON 71 EPTN / lJ / STATE PPER REGISTRATION NO. ® COUNT ANHOLE REF ERENCE . NO. DESCRIPTION OF/WORK FEEYPE OF CONNE 10 LEN H FROM O HOUSE SEWER CONN NG TO Y. U M.L. O P.L. '�� / V PUBLIC SEWER @ $5.00 P.C.NO. 9x SEPTIC TANK,SEEP PIT OR PITS ANDOR DRA IELD @ $10.00 CO.IMP.NO. JOB NO. [0 HOUSE SEWER C NECTING TO TRUNK PERMI/NO. ROAD PERMIT 199 PRIVATE DISPO SYSTEM @ $3.00 CONNECT AD T ONAL BLDG.OR AFFIDAVIT WAIV SEMENT RECORD.INSTR.NO. A E WORK TO H E SEWER @ $3.0 //O�OVERFLOW EPAGE PIT,DRAINFIELD EXTN..0 ES O L.DRYWELL,MANHOLE @ $ ALTER, IR OR ABANDON HOUSE HWY OR T.W ING SEWER DISPOSAL SYSTEM @ .00 5 AT R HMENT 42L49 11 E T O. DUST / ASTE PPROVAL CHS RG ES AUTHORIZATION TO L E $ C C NNECTION CHARGE FEE J REIMBURSEMENT FEE I HAVE AT THIS DATE A C RA WITH THE HEREIN NA CON- TtK RACTOR TO CONNECT T AB E DESCRIBED EXISTING ELL APPRO LS TO THE PUBLIC SEWE DATE INSPECT SSIGNATURE SIGNED THIS D Y OF 19 OWNER OR NEW HOUSE EWER OWNERS AGENT / CONNECT DDITIONAL ADDRESS BU ILDI OR WORK SEPTA TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE REA THIS A PLICATION A /OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AN AGREE O COMPLY WITHALL COUNTY ORDINANCES AND STA LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL 1 HEREBY CERTIFY THAT I AM PROPERLY REGI T AND�O ALTER,REPAIR,SEWE R LICENSED AS REQUIRED BY S ANGLES COUNT ND TATE SEWAGE DISPOSAL ST CALIFORNIA OR THAT I AM LEGAL OWNER O , NO NTEN O DISCONNECT P G A RESIDE IN, THE ABO D IBED RE IDENTIA L� P OP RTY. ABANDON HO E 5 ER SIGNATURE / /' BACKFIL EPT TANKS ❑ OF PERMITTEE SEEP,P (S) CESSPOOLS ❑ ALIDAT ROBERT A. WOOD M.O CASH SUPERVISING MECHANICAL ENGINEER CK. t 210GNOV 4 1 1 D 25.00~ ck, - -CANCELLED M UgM f ,U.82 76A642D APPLICATION FOR PER IT 78A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ,� A JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN. Sup't of Building LOCALITY .�r NEAREST FOR APPLICANT TO FILL IN CROSS 5T. LEGAL © ' DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY �'�,1� .f� r 7• TEL. NO. USE OF r BUILDINGS � � � DISTRICT NO. GROUP MAP PROC ES D BY BK PG � CONTRACTOR �lJ9 J/�T � ADDRESS — v CONNECTION ATA STAT ION e �} DEPTH CITY TEL. NO. V ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO. ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM 0. HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. O PUBLIC SEWER @ $5.00 .� P.C.NO. V SEPTIC TANK,SEEPAGE PIT OR MPNOJOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.. . . � HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM e° $3.00 }� CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER I EASEMENT RECORD,INSTR,NO. DATE WORK TO HOUSE SEWER @ $3.00 LU W 106 OVERFLOW SEEPAGE PIT,DRAINFIELD h EXTN.,CESSPOOL,D RYWELL,MANHOLE @ $5.00 z }!ABANDON HOUSE .3 HWY.OR ST.WIDENING SEWER "�"L SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. 4NDUSTRIA STE A R V ' HAR B OWNERS PERMIT $ 2 Oo �.� C N EC I CH R. E AUTHORIZATI N TOTAL FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. RE B N FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEW APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS RAY 19.� OWNER OR , NEW HOUSE SEWER OWNERS AGENT � •'" '� '�'�`"'�� CONNECT ADDITIONAL BUILDING OR WORK ADDRESS O6 ' SEPTIC TANK,SEEP,PIT(5) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS 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 COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THnLEGAL OWNER OF, ND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE AB VE D 5 E RESID N,TIAL P PERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE �l ts�!'' '�'.� BACKFILL SEPTIC TANKS ❑ ( .. SEEP. .IT (S) ❑ CESSPOOLS ❑ & VAL FrTION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. i k D_82 76A642D APPLICATION FOR PER IT 8A842 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ' JOHN A. LAMBIE, County Engineer ADDRESS (f do— DA. WILLIAM A. JENSEN, Sup't of Building LOCALITY �ir♦ �� NEAREST FOR APPLICANT TO FILL IN CROSS ST. ,,'q LEGAL I DESCRIPTION LOT NO. 7 OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLD GS. SIZE OF LOT NOW ON LOT CITY TEL. -NO. USE OF DISTRICT NO. GROUP MAP P OCES /BY BUILDINGS -4i BK PG CONTRACTOR C. A. Davis 6,O7� ADDRESS (172(0 W. 139th Street V NNECTION DAT CITY Gardena TEL. NO. FA 1-9060 ATION ! © DEPTH REGISTRATION NO. 203132 ElxCOUNTY TATE MANHOLE RE E E NO. DESCRIPTION OF WORK FEEYPE OF O IO LE TH FROM 0 d PUOBL C SEWER HUSE SEWERCONN ECTING TO $5.00 U`-Z� A M. TO P.L. 2 P.C.NO. O SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. .108 NO. PITS AND/OR DRAINFIELD @ $10.00 ////''''''�]]�]] � HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N� O PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DA E W WORK TO HOUSE SEWER @ $3.00 d OVERFLOW SEEPAGE PIT,DRAINFIELD (am EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 HWY.OR ST. DENING yy ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $3.00 STATE EN H PERMIT INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 0-r::> I HAVE 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 SIGNATUR� SIGNED THIS DAY OF 19_ _ OWNER OR NEW HOUSE SEWER J ✓� ,�%:�' ? OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK .. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(5) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS 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 COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I A THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE SCRIBE RESIDE L PR OPFERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD UCI M.O. CASH SUPERVISING MECHANICAL ENGINEER L"22091 0 NOV 4 1 0 D 7.0 O N d �i- �7- & �