HomeMy Public PortalAbout4919 ARDEN DR_Sewer__ 78A9420 APPLICATION LICO"o1ION F® PERMIT
1
S&'E-689 11.58"
0 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS, ej w azo
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN ceoss sT.
LEGAL OWNER
DESCRIPTION LOT NO. j'�
MAIL
BLOCK TRACT /0 �6U ( ADDRESS ii di .
NO. F BLDG S Y 6�
SIZE OF LOT fox NOW ON LOT�„ CITY TEL. N
USE OF F
BUILDINGS DISTRICT NO. GROUP MAP
-
J ` BK PG
CONTRACTOR � t, _:v S L`��
CONNECTION DATA
ADDRESS ��y i �'• f
CITY �Y��+ TEL. NO. 1 y;. STATIONDEPTH
Z 1114
MANHOLE REFERENCE
'E °STATE LOWER
REGISTRATION N0. ,® ❑ COUNTY
NO. DESCRIP ION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CS,Zy,I�CTION LENGTH FROM
PUBLIC SEWER @ $3.50 � (�
Y. /CURB 7 P.L. M.L.TO P.L. �.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD J C.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 k. CO. IMP. N0. J � OB NO.
HOUSE SEWER CONNECTING TO fly
y rlO
PRIVATE DISPOSAL SYSTEM @ $1.00 � TRUNK PERMIT N0. ROAD PERMIT NO.%//J '�_ '
CONNECT ADDITIONAL BLDG.ORt=eSTATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
i
CHARGES
r CONNECTION CHARGE FEE
OWNER'SPERMIT � 1 00
AUTHORIZATION I TOTAL FEEis
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED coN- APPROVALS DATE INSPECTOR'S SIGNATURE
F; TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER'. NEW HOUSE SEWER
SIGNED THIS D Y O 19 CONNECT ADDITIONAL '
OWNER OR BUILDING OR WORK
OWNERS AGENTja -� SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ- THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND '
LENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LE^ OWNER OF THE ABOVE
DESCRIBED RESIDENTI PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP.PITS) ❑ CESSPOOLS❑ `
OF PERMITT
JOHN A. LAMBIE. UNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
0. CASH
�_Co 9 5 5 DEC 9 4 5.5 0