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Home My Public Portal About4934 ARDEN DR_Sewer__ i 420 3-E4 76A6APPLICATION FOR PE MIT 76A64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building LOCALITY l 1 NEAREST FOR APPLICANT TO FILL IN CROSS 5T. LEGAL DESCRIPTION LOT NO. OWNER /x, MAIL BLOCK TRACT V ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP CESSED BY BUILDINGS BK PG CONTRACTOR S Iva, .014 .i'q-o*l ADDRESS dF fLt�.,vj CONNECTION DATA CITY TEL. NO. I ATION DIPTH ❑ STATE UPPER REGISTRATION NO. ❑ COUNTY MANHOLE REFERENCE L••� NO. DESCRIPTION OF WOK FEE TYPE OF CON C LENGTH FROM HOUSE SEWER CONNECTING TO Y. C P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 P.G.NO. Y' SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. JOB NOO PITS AND/OR DRAINFIELD @ $10.00 . HOUSE SEWER CONNECTING TO , PRIVATE DISPOSAL SYSTEM @ $3.00 TRUNK PERMIT NO. ROAD PERMIT O 2 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER @ 53.00 OVERFLOW SEEPAGE PIT.DRA NFI D EXTN..CESSPOOL,DRYWELL, N O E @ $5.00 W ALTER,REPAIR OR AB DO H U E HWY.OR ST.WI N SEWER" EWE DISPOSA YS @ $3.00 STATE ENCROACHME T PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY/O 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(5) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IV PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE E DEESSCAR`IB EDD�.RESIDENTIAL �jP/$ ERTY. ABANDON HOUSE SEWER SIGNATURE APERMITT t/ - L�/"'r "►i/ A KFILL SEPTIC TANKS ❑ PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.O. SUPERVISING MECHANICAL ENGINEER CASN L1u0224 £'1'03 :JUN 311D 25.00- 1; L 3-E4 76A642D MIAPPLIC�►TION FOR PE T 6A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS 4qk ` WILLIAM A.'JENSEN, Sup't of Building LOCALITY NEAREST [7BLOCK R APPLICANT TO FILL IN CROSS ST. LOT NO. OWNER e� MAIL TRACT /� ADDRESS NO. OF BLDGS. NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS tBK PG CONTRACTOR r ADDRESS CONNNECTION DAT CIT TEL. NO.�v �� S ATION DEPTHA ❑ STATE MANHOLE REFERENCE ( UPPER REGISTRATION NO. ❑ COUNTY J NO. DESCRIPTION OF WORK FEE TYPE OF CO N LENGTH FROM HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.G.NO. } PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. O_ O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT V PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 Q OVERFLOW SEEPAGE PIT,DRAINFIELD EX TN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 U ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDE lJ.l CL SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT) N y PERMIT NO. i V INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE '1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY F 19_ OWNER OR NEW HOUSE SEWER II ,lly, OWNERS AGENT V CONNECT ADDITIONAL BUILDING OR WORK ADDRESS 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 WIT HALL 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 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 ABO ESCRIBEO RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE KFILL SEPTIC TANKS ❑ OF PERMITTEE P IT(S) ❑ CESSPOOLS ❑ VALIDA OROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER L f � 2 2 4 7%-0 JUN 3 1 0 D 7.0 0� �'