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Home My Public Portal About4917 ARDEN DR_Sewer__ 76A°642D•6 APPLICATION FOR PERMIT 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 -7011"A2 NEAREST FOR APPLICANT TO FML IN CROSS ST. ' LEGAL DESCRIPTION LOT NO. OWNER MAILE�..�+Q BLOCK TRACT � � �� ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITU ♦• TEL. NO. USE OF t BUILDINGS DISTRICT NO, GROU MAP PROCESSED BY —0 BK PG CONTRACTOR ADDRESS �. ` CONNECTION DATA CITY TEL. NO. STATION DEPTH STATE I`) (}'/ l� LIC MANHOLE REFERE CE UPPER LICE.NS Idb'�D CLASS LOWER N0. DESCRIPTION OF WORK FEE TYPE OF CONN E ON LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB .L. M.L.TO P.L. ' PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C. . PITS AND/OR DRAINFIELD "@ $10.00 CO.IMP. NO. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERM O. PRIVATE DISPOSAL SYSTEM @ $3.00 � s O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT YER EASEMENT RECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL,DRYWELL.MANHOLE @ $5.00 O ABANDON HOUSE HWY.OR ST.WIDENING C') 4kN5111311111111MDISPOSAL SYSTEM $3.00 STATE ENCROACHMENT CLLJ L PERMIT NO. Cn INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ x 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 IN ECTOR' GNATURE SIGNED THIS DAY OF ig_ OWNER OR NEW HOUSE SEWER / OWNERS AGENT_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP.PITS) IH 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 SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY 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 ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMfiTEE � //� BACKFILL SEPTIC TANKS ❑ SEEP.PITS) ❑ CESSPOOLS ❑ VALIDATION JACK R. ALLEN K., M.O. CASH SUPERVISING MECHANICAL ENGINEER i Ar_ 9 8 8 0 APR 2 3 1 0 0 5.0 0 C c i 10-63 76A642D APPLICATION FOR PERMIT 6A642 , COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADDRESr J.' (� JOHN A. LAMBIE, County Engineer 4 /WILLIAM A. JENSEN, Supt o4 Building NEARE . FOR APPLICANT TO FILL IN LEGAL 1 Y DESCRIPTION LOT NO. „`, OWNERMAIL �� BLOCK TRACT �0 � ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY ( TEL. NO. USE OF DISTRICT NO. GRMAP PROCESSED BY BUILDINGS OUP BK PG CONTRACTOR p�.J 64 Y b r\ S19s ADDRESS � {�' L(�.Q CONNECTION DATA /1 STATION f"- DEPTH Q CITY TEL. NO.' �f (,J C� STTE MANHOLE REFERENCE J REGISTRATION NO. �L�.C� ❑ COAUNTY NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO �^ Y. CURB P.L. M.L.TO P.L. J d ' PUBLIC SEWER @ $5.00 0 P.C.NO. O SEPTIC TANK.SEEPAGE PIT OR NO IMP. . PITS AND/OR DRAINFIELD @ $10.00 CO. JOB NO. / V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N ® � L PRIVATE DISPOSAL SYSTEM @ $3.00 J CJ /1 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR,NO. DATE 0 WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT,OR INFIELD Uj EXTN.,CESSPOOL,DRYWELL,MA NHOLE @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING SEWER OR DIS OSAL SYSTEM $3.00 STATE ENCROACHMENT z PERMIT NO. INDUSTRIAL WASTE APPROVAL OVNER'S PERMIT $ z 00 CHARGES AUT ORIZATION TOTAL FEE D 1 CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED GOWN REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORiS SIGNATURE SIGNED THIS DAY OF 19_ Y 1 I OWNER OR NEW HOUSE SEWER OWNERS AGENT q' CONNECT ADDITIONAL /1t ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) v 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 ❑ IHEREBY CERTIFY THAT I AM PROPERLY RE ISTEREO AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COU Y AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB E DESC BED R IDENT AL F 2OPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITT EE. SEEP.PIT(S) ❑ CESSPOOLS ❑ i ALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. �.,;;J.� E 4 e2 8� DSC 3 1 Q D 7,C) 0- 17. �J J1✓lL��rs