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Home My Public Portal About4937 ARDEN DR_Sewer__ y- CEBOB 3-62 76A6421) APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESSY'CZeA •* — WILLIAM A. JENSEN, Sup't of Building LOCALITY Temple Cit NEAREST Freer FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. 13 OWNER MAIL BLOCK 'f TRACT ADDRESS 8700 00 Las Tunas SIZE OF LOT 0+22 NOWOON LOTS 10CITY m ;~ -I N EL. NO. USE OF BUILDINGSDISTRICT NO. GROUP MAP . 00ESSED BY IR en/ �) PG CONTRACTOR H. Williams _�d � � ' Z ADDRESS 2315 E. 118 St• CONNECTION DATA TION % DEPTH CITY TEL. NO. _ CCJI 0 STATE UPPER REGISTRATION NO. 139099 ❑ COUNTY MANHOLE REFERENCE NO. DESCRIPTION OF WORK FEE TYPE OF CON E N NGTH FROM HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. PUBLIC SEWER $5.00 P.C.N PITS AND/ O. SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. JOB IN (,f OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. IOL PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL BLDG.OR - AFFIDAVIT I WAIVER I EASEMENT REC RD.INSTR,NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD _ Q EXTN..CESSPOOL.DRYWELL.MAN HOLE @ $5.00 1 9 ALTER,REPAIR OR ABANDON HOUSE -- HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM _@_ $3.00 STATE ENCROACHMENT PERMIT NO. - ------- ------ -- INDUSTRIAL WASTEAPPROVAL CHARGES OWNERS PERMIT $ 2 00 - AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO 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_ New CONNECT ADDITIONAL ' ADDRESS BUILDING OR WORK 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 -- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT 1 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 AB E ESCRIBED RESIDENTIAL P P TY. ABANDON HOUSE SEWER SIGNATURE ! f�J .�� BACKFILL SEPTIC TANKS ❑ OF PERMfTTEE P.PIT(S) ❑ CESSPOOLS ❑ VALIDATION---, ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH 76A642D-62` APPLICATION FOR PERMIT �..�� 76A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEARE JOHN A. LAMBIE, County Engineer Efl' d r• WILLIAM A. JENSEN, Sup't of Building Temple Cit Freer FOR APPLICANT TO FILL IN . LEGAL DESCRIPTILEGA L ON LOT NO. OWNER 14r, TOY risen MAIL BLOCK A TRACT r]11]1148 ADDRESS 0 L Tunas SIZE OF LOT 10Uf224 NOWOON LOTS CITY �.eJ%I le Cit TEL. NO. USE OF DISTRICT NO. GROUP SK MAP PG PROCESSED BY BUILDINGS CONTRACTOR H. iliums- � ADDRESS 2315 E, 118St• CONNECTION STA ON DEPTH S� CITY TEL. NO. — L"J STATE REGISTRATION NO.139099 ElCOUNTY MANHOLE REFERENCE UPPER / NO. DESCRIPTION OF WORK FEETYPE OF ONNECTIO LENGTH FROM - HOUSE SEWER CONNECTING TO Y. 'CU .L, M.L.TO P.L. PUBLIC SEWER @ $5.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR CO. IMP. NO. JOB NO. PITS AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMEKT RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD (o]e EXTN..CESSPOOL.DRYWELL,MAN p LE @ $5.00 Q¢} H WY.OR ST.WIDENING ALTER.REPAIR OR ABANDON . SEWER OR DISPOSAL SY E @ $3.00 STATE ENCROACHMENT ul PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERCHARGES S PERMIT $ " AUTHORIZATION I 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 rDATE,." INSPECTOR'S SIGNATURE SIGNED THIS DAY OF OWNER OR '�T NEW HOUSE SEWER OWNERS AGENT_ Ne�t� CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO/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 I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOV DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER 7 a � o SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ SEEP,PITS) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD I M.O. CASH SUPERVISING MECHANICAL ENGINEER CK.! rr r�