HomeMy Public PortalAbout5003 ARDEN DR_Sewer__ ?e. DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
NI
r WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
FOR AP LICANT TO FILL IN LOCALITY I )
BUILDING NEAREST
ADDRESS CROSS ST. �C 1 0�
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A l � 144-S
CROSS ST.
RECEIVED BY Ready for Inspection 1 DATE ISSUED �
OWNER 2 /4 /5`'3
MAILUSE ZONE OCCUPANCY 'MAP�
ADDRESS
B!( PG
CITY TEL.NO. t)�_ J A_—I L e SO
CONTRACTOR (,• c�
CO.IMP.N0. c�
ADDRESS JOB NO. -
CITY TELAO. TRUNK PERMIT NO.
STATE
REGISTRATION NO.
® COUNTY ROAD PERMIT N0. F t5 4 0 I
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK _ a'TRACT INDUSTRIAL --
WASTE APPROVAL
SIZE OF LOT NOW ON LOTS CHARGES
USE OF
s
BUILDINGS � CONNECTION'CHABGEFEE
NO. DESCRIPTION ITF WORK FEE ✓
REIMBURSEMENTFEE�
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 _lr'ly RECEIPT NO. I DATE�I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING - NO. I DATE I BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER /
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ,J��
_ PITS AND/OR DRAINFIELD 2.00 STATION rT� ' DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 A 1 MANHOLE REFERENCE
1llC� f1 LOWEJW
S TYPE OF C_O.NNECTION LENGTH FROM
OWNERS PERMIT $ I 00 + Culi6� erg, M.L.TO P.L. 4
AUTHORIZATION I TOTAL FEE '
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
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
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL1- CESSPOOL ORYWELL 11
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH,ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE.ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFI LL SEPTIC TANKS E]
SIGNATURE //JJ���� fj� �' SEEP.PIT(S)C] CESSPOOLS g, - rJC �i1-p oot
OF PERMITTEE `--------- ---- _:..
76A642A 663 7/53 c-