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HomeMy Public PortalAbout4915 ARDEN DR_Sewer__ • C��"fes%'L��� 6A6426 -69 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7NEAREST /ym Q �r�u yrs JOHN A. LAMBIE, County Engineer V1> C W WILLIAM A. JENSEN, Sup't of Building /— ��[� FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. �j E D �(/` MAIL BLOCK TRACT ADDRESS NO. OF BLDG S. SIZE OF LOT NOW ON LOT CITY t �� TEL. NO. USE OF DISTRICT NO. GROUP MAP P OCESSED BY BUILDINGS BK PG(� CONTRACTOR `J�� r D ,� L X ADDRESS I �._(,/� p CONNECTION DATA S��g STATION i DEPTH n CITY CC EL. NO. f �p STATE COUNTY MANHOLE REFERENCE REGISTRATION NO. UOW ER �_�.--i-1 J NO. DESCRIPTION OF WORK FEE TYP OFC N TI LENGTH FROM r } / HOUSE SEWER CONNECTING TO @ $5.00 5 Q Y C R P.L. M.L. TO P.L. PUBLIC SEWER P.C.NO. CL SEPTIC O TANK,SEEPAGE PIT OR JOB NO. PITS AND DRAINFIELD @ $10.00 CO.IMP.NO. y� V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N /!rI 5r PRIVATE DISPOSAL SYSTEM @ $3.00 (J✓ 0 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT.DRAINFIELD UJI EXTN.,CESSPOOL,DRYWELL,MA NH OLE @ $5.00 d ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WI INGIfa N SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCRO ` PERMIT N INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT 21 00 AUTHORIZATION TOTAL FEE ©i\ CONNECTION CHARGE FEE A 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 Y ;` SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER -- OWNERS AGENT CONNECT ADDITIONAL llr BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) IH 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 ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY A STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM TH LEGAL OWNER OF, INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB E DESC D ESIDENTI AL P PE TY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS E]SEEP,PIT(S) ❑ CESSPOOLS ❑ VAM.O. CASH IDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. L"tk10 6 4 2 6 IZ6 DEC 3 1 0 D 7.00- C 6808 1 0-63 76A642S APPLICATION FOR PERMIT" COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUI7 - ST }� JOHN A. LAMBIE, County Engineer ADD WILLIAM A. JENSEN, Supt of Building LOCCRO -S FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY J . f TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS �S BK PG CONTRACTOR � � ADDRESS �Q (I�- (�-i.�0 Q CONNECTION DATA �ry STATION I DEPTH CITY 0 hyJ� TEL. NO. � n A • STATE MANHOLE REFERENCE " `L REGISTRATION NO. COUNTY AaA, l� 1` NO, j DESCRIPTION OF WORK FEE TYPE F O �pcT,^", LENGTH FROM HOUSE SEWER CONNECTING TO Y. �J'/1�eI.R'B-�� P. M.L.TO P,L. } PUBLIC SEWER @ $5.00 - 9. SEPTIC TANK,SEEPAGE PIT OR P.C.NO. '� PITS ANDlOR DRAINFIELD @ $10.00 CO. O IMP. NO. � JOB NO. ^51:,? �..�* f U HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N �r PRIVATE DISPOSAL SYSTEM @ $3.00 G/✓ VVCJ O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT,DRAINFIELD �W EXTN„CESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.W I SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT •L PERMIT NO. f y D��� C �� INDUSTRIAL T/'/C WASTE APPROVAL OWNERS PERMIT $ =411v CHARGES 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 DAY OF —19— OWNER 9_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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ Q (/ I HEREBY CERTIFY THAT I AM PROPERLY R ISTERED AND/OR ALTER,REPAIR,SEWER OR .,. LICENSED AS REQUIRED BY LOS ANGLES CO Y AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I A L AL OWN OF, AND INTEND TO RESIDE IN, THE ABO ES IB ESIDE AL PROPERTY. DISCONNECT PLUG AND O ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ ” ❑ SEEP.PIT(S) ❑ CESSPOOLS I ALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. Lw54271'103 DEC 311 D 25.00— c"