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Home My Public Portal About4933 ARDEN DR_Sewer__ cE808-8-ss APPLICATION FOR PERMIT _ 1 >aoa-a COUNTY OF LOS ANGELES SEWER-SEWAGE ® SPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS e CASSATT D. GRIFFIN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN -c"SS ST. � � �� del LEGAL OWNER DESCRIPTION LOT N0. ' BLOCK TRACT �OO MAIL ADDRESS O.OF BLDGS. SIZE OF LOT ON LOT CITY TEL.NO. USE OF BUILDINGS % -� ,;,.,, :,,= = !�f DISTRICT NO. GROUP MAP PROCESSED BY ' CONTRACTOR >� ADDRESS ~✓� CONNECC�TJJJIONUUUDATA CITY �t�q°o7 TEL. MO. �f� STATION 01 DEPTH MANHOLE REFERENCE � UP R REGISTRATION NO. c UN COT -f7Y COWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $8.00 ®o TYPE OF CTION LENGTH FROM f SEPTIC TANK,SEEPAGE PIT OR Y. CURD P.L. M L TOP L PITS AND/OR DRAINFIELD @ $8.00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. - JOB N0. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. ALTER, REPAIR OR ABANDONHOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES. OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE Cp I�Q` REIMBURSEMENT 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. SIGNED THIS DAY OF 19- NEW HOUSE SEWER 5`/j� �J Tr-- Oa. OWNER OR4 c ! [ CONNECT ADDITIONAL' �Lt OWNERS AGENT- y -`4-�-. 4" �, .% f).' �.(' ( to->r., /J BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD LDESCRIBED HE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION TATE. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑ ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR ING AND SEWERS. SEWAGE DISPOSAL SYSTEM REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ED AS REQUIRED BY LOS ANGELES COUNTY AND STA;;E OF ABANDON HOUSE SEWER RNIA OR THAT AM THE LEGAL OWNER OF., THE ABOVE RESIDEN L ROPERTY.'' BACKFILL SEPTIC TANKS❑ URESEEP.PIT(S) ❑ CESSPOOLS❑RMITTEE » ®� VALIDATION ROBERT A.WOOD gg, N.p, Cult SUPERVISING MECHANICAL ENGINEER ' , � ,61 7 2En MAY 5 1 0 A 5 .00 t� D CESOO-e-se APPLICATION ION FOR PERMIT 1 eaoe- COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER :• lZal BUILDING AND SAFETY DIVISION BUILDING ' JOHN A. LAMBIE, County Engineer ADDRESS -� CASSATT D. GRIFFIN, Sup't of Building LOCALITY NEAREST CL FOR APPLICANT TO FILL IN CRO"ST. LEGAL DESCRIPTION LOT NO. OWNER BLOCK TRACT MAIL ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL.NO. USE OF BUILDINGS DISTRICT N0. GROUP MAP PG PROCESSED BY _ CONTRACTOR ADDRESS ECTION DATA CITY fcch TEL. N0. STATION DEPTH ATE MANHOLE RE RE E UPPER IREGISTRA fON N0. COUNTY LOWER NO. DESCRIPTION OF WORK FEE r� HOUSE SEWER CONNECTING TO - PUBLIC SEWER @ $3.00 TYPE 0 CONNECTION LENG FROM SEPTIC TANK,SEEPAGE PIT OR Y. URB P.L. .TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD - EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO C.NO. u' PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. .JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. - ROAD PERMIT NO. WORK TO HOUSE SEWER @ $1.00 ALTER,REPAIR OR ABANDON HOUSE STATE ENCRO MENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT N0. INDUSTRIA WASTE A PROVAL CZ V CHARGES OWNERS PEST $ 2 Op CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 0-tl�p REIMBURSEMENT 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. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND-STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ _ SIGNATURE F r� � Q , SEEP.PIS) ❑ CESSPOOLS E](/11 T OF PERMITTE OF ALMATION ROBERT A.WOOD cK. N.o. CASH SUPERVISING MECHANICAL ENGINEER I ACO 6 3 5 4-u FAY 14 C o A 3.0 a 1