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Home My Public Portal About4914 ARDEN DR_Sewer__ 7EB08 10-ea APPLICA IOM. F°OR PEWMIT° 78A eazo- ; —11 I COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL U DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDINa JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS % �y COLEMAN W. JENKINS, SUPT. OF BUILDING �9 LOCALITY NEAREST FOR APPLICANT TO FII.L IN CR LEGAL DESCRIPTION LOT NO. OWNER 6. a s MAIL Y p.�o BLOCK TRACT ADDRESS NO. OF BLDGS. � % - SIZE OF LOT / NOW ON LOT C TEL. NO. USE OF DISTRICT NO. GRO P MAP PROCESSED BY BUILDINGS t/j� GLS CONTRACTOR�j,� �.�P. � BK �•i 4 ADDRESS O �G/77 $ V JI'/ C/ONNECTION DATA CI SEL. NO�(d�� f�O TION .Y DEPTH < STATE5,&L NO:CP- 5&L�N CIC Be- r/ �/ MANHOLE REFERENCE -� / LOWER r NO. DESCRIPTION OF WORK FEE TYPE OF C. NN T LENGTH F '�// HOUSE SEWER CONNECTING TO Y. C M.L.TO P. PUBLIC SEWER @ $5.00 1 -5 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD J @ $10.00 CO.IMP.NO. 309, JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NOf� }' PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.ORAFFIDAVIT wA1vER [�5[M[Ni RECORD.INSTR.NO. DATE O WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT.DRAINFIELD O EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 HWY.OR ST.WIDENING ~ ALTER.REPAIR OR ABANDON HOUSE V SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT LLI d PERMIT NO. (n INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT sl z 00 AUTHORIZATION TOTAL FEE 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 TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS AY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 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 SEW S. CESSPOOL ElDRYWELL ❑ I HEREBY CERT.-07/ I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSEUNH IR Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORAT M THE LEGAL WNER AND INTEND TO DISCONNECT PLUG AND RESIDE B DESCRIBED R DENTI PROPERTY. ABANDON HOUSE SEWER SIGNATUOF PEBACKFILL SEPTIC TANKS ❑ SEEP.PITS) ❑ CESSPOOLS ❑ V ATION CK. M.O. c � JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER { �.r 9 4 6 1 igikR 3 1 1 v D 7.0 0 76A 6 #3n . APP BST A TION OR WERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT. OF BUILDING .� LOCALITY NEAREST ` FOR APPLICA T TO FILL IN CROSB 3 LEGAL DESCRIPTION LOT NO. �/rj� OWNER r MAIL BLOCK TRA ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG IV 4CONTRACTOR t / ,�''- ADDRESS CONNECTION.DATA ' CITY O. / • T ION DEPTH a STATE ) LIC MANHOLE REFERENCE LICENSE NO �il� CLASS a LOWER NO. DESCRIPTION OF WOR FEE TYPE OF CO -ECTI LENGTH ROM' HOUSE SEWER CONNECTING TO Y. M.L.TO .L. PUBLIC SEWER @ $5.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ 810.00 CO. IMP. NO. JOB NO. e HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, y� PRIVATE DISPOSAL SYSTEM @ 83.00 G 4/ O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wl11YER I EASENENT RECORD.INSTR.NO. DATE V WORK TO HOUSE SEWER @ 83.00 OVERFLOW SEEPAGE PIT.DRAINFIELD C) EXTN..CESSPOOL.DRYWELL.MANHOLE @ 85.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING W Sg.IAJER OR ISPO ALSYS TEM 83.00 STATE ENCROACHMENT D" PERMIT NO. Z: INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT s CHARGES 30 16" CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 1 HAVE AT THIS DATE A .CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR T0.CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS D OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(5) 1 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 H I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REOUI Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR T THE LEGAL OWNE OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE B DESCRIBED ESID N AL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERM TEE SEEP.PIT(S) ❑ CESSPOOLS ❑ -VAUDATION JACK R. ALLEN CK. M.0. SUPERVISING MECHANICAL ENGINEER CQ d!'� 9 4 6 2" MAR 31 12 D 30-00-