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Home My Public Portal About4922 ARDEN DR_Sewer__ 2D 10-63 76A646A642 `• APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /� � w _) JOHN A. LAMBIE, County Engineer ADDRESS i rC Cl eA) /e— WILLIAM A. JENSEN, Supt of Building �1 LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS BT. p tam LEGAL Q DESCRIPTION LOT NO. 67OWNER MAIL BLOCK TRACT ADDRESS f K�dP NO, OF BLDGS. //'� SIZE OF LOT NOW ON LOT CITY lip�7J Ci Ey NO. USE OF .DISTRICT NO. ROUP MAP PROCESSED BY BUILDINGS N BK P�G�/y�� _ CONTRACTOR ` �!. en {jam. ADDRESS a y Z�- CONNECTION DATA CITYor�'F�,..Z_��- STATION DEPTH A TIE UPPER REGISTRATION NO. eels.-7 COUNTY MANHOLE REFERENCE LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING Tp Y. CURB P.L. M.L.TO P.L. d PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. O CO.IMP. NO. JOB NO. PITS AND/OR DRAINFIELD @ $10.00 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. Ix PRIVATE DISPOSAL SYSTEM @ $3.00 /1 CONNECT ADDITIONAL�� y� 0 AFFIDAVIT WAIVER EASEMENT RECORD, INSTR.NO, DATE 0V WORK TO HOUSE SEWER @ $3.00 �(� OVERFLOW SEEPAGE PIT.DRAINFIELD W EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 a ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING Ny SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT 6 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s 2 00 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 OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL - 12""/ BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) 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 OS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I T E LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOV DE RIBED RESIDEN L PROPEPTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PITS) ❑ CESSPOOLS ❑ (gALIDATION ROBERT A. WOOD CK.. M.O. CASH SUPERVISING MECHANICAL ENGINEER L1110 6 7 3 9 DEC 11 1 0 D 5.00- � e p .e 6A642D 70-63 '- APPLICATION FOR PERMI 6A642 COUNTY OF.LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS o '��y WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS sT. c (L}I Lf FBUILIDINGS EGAL .I� �� RIPTION LOT NO. OWNER > MAIL K TRACT ! ADDRESS / NO. OF BLDGS. OF LOT NOW ON LOT CITY TEL. NO. OF DISTRICT NO. GRO MAP PROCESSED BY G h I - c. /( /J BK PG CONTRACTOR 1,9 n� ADDRESS G/ _ !'� � a fl - CONNECTION DATA STATION DEPTH CITY y�-1, - ."j TEL. N0. ❑ STATE MANHOLE REFER CE UPPER REGISTRATION NO. ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNEC N GTH FROM HOUSE SEWER CONNECTING TO Y. CURB M.L.TO P.L. PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR ;OB NO O PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JV HOUSE SEWER CONNECTING TO TRUNK PERMIT ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 111 0 CONNECT ADDITIONAL BLDG,OR AFFIDAVIT I WAIVER I EASEMENT RECORD,INSTR.NO. DATE I' WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT,DRAINFIELD 64A EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $5.00 a ABANDON HOUSE HWY.OR ST.WIDENING N SEWER SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL (� �) WASTE APPROVAL 73'1 e CHARGES OWNERS PERMIT S 2 00 CONNECTION CHAR E FEE AUTHORIZATION TOTAL 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 DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PITtS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL 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 LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT,1.6M THE LEGAL OWNER OF, AND INTEND TODF6G@NN@C•T�CUG AND ,( RESIDE IN. THE ABOVE DESCRIBED RESID//EN,'AL PROPERTY. ABANDON HOUSE SEWER SIGNATURE ds •t� . y�,_ BACKFILL SEPTIC TANKS [7)E. OF PERMITTE .� 1/11. /// ❑ -- - SEEP.PIT(S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH L,ti1;o 5 3 9 1-0 OCT 2 9 1 0 D 5.0 0 7 -663 11.59 &EAPPLICATION FOR PERMIT S&E-66 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D I S POSH L Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS_ ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. LEGAL OWNER DESCRIPTION LOT NO. CO MAIL BLOCK TRACT ADDRESS ` 444 1- NO. OF BLDGS. J CITY TEL. SIZE OF LOT NOW ON LOT •.v USE OF 449 BUILDINGS DISTRICT NO. GROUP BK MAP PG CONTRACTOR P 5 v r t � CONNECTION DATA ADDRESS A Z_ may` �.7 ar� �. y /` STATION b I . DEPTH CITY �'V'A. TEL. NO. �S 4J MANHOLE REFERENCE _U_a fiR REGISTRATION N0. [ICCOLOWER TY NO. DESCRIPTION OF WORK FEE - TYPE OF CB:N.M CTION LENGTH FROM V - HOUSE SEWER CONNECTING TO ° Y. ((CURB P.L. M.L. TO P.L. PUBLIC SEWER @ $3.50 V �` SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO. EXTN.,CESSPOOL,DRYWE LL,MANHOLE t@ $2.00 CO. IMP. NO. -� JOB NO. HOUSE SEWER CONNECTING TO �Q �0 PRIVATE DISPOSAL SYSTEM Qi $1.00 TRUNK PERMIT N0. ROAD PERMIT N CONNECT ADDITIONAL BLDG. OR STATE ENCROACHMENT WORK TO HOUSE SEWER a $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR-DISPOSAL SYSTEM a $1.00 WASTE APPROVAL CHARGES p CONNECTION CHARGE FEE, , OWNERS PERMIT $ 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER ��i�� SIGNED THIS Y OF 19 CONNECT ADDITIONAL OWNER OR 'ILDING OR WORK Ole WNERS AGENT SEPTIC TANK,SEEP, PIT($) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THI 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR D DISCONNECT PLUG AN LICENSED AS REQUIRED BY S ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I A THE LEGAL WNER OF THE ABOVE DESCRIBED RESIDENTIAL P PERTY. BACKFILL SEPTIC TANKS E:1 /' SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS n OF PERMITT GJ.r�.,is/.'i � %v,:`��:•' � a%�•�� JOHN A. LAMBIE, C TY ENGINEER VALIDATION ROBERT A: WOOD, CHIEF PLBG. INSPECTOR CASH 1.CflrLl� 4 0 2— AUG 21 . 4. 450 9