HomeMy Public PortalAbout5011 ARDEN DR_Sewer__ CEBO82361 -
76A642D A6 Y LICATION OR PERMIT- '
I- 9 -� � '
COUNTY OF LOS ANGELES SEWER=SEWAGE ®ISPOSAL.
DEPARTMENT OF COUNTY'ENGINEER
BUILDING AND SAFETY DIVISION BUILDING q
JOHN A, LAMBIE; County Engineer ADDRESS'. .0 hWjPRqCESSjCD
.Cl
WILLIAM A. JENSEN, Supt of Building
LOCALITY
— NEAREST
FOR APPLIC T TO IN / CROSS ST:LEGAL
DESCRPTION LOT NO. Tr' GHEE OWNER
BLOCK TRACT MAIL
ADDRESSNO.OF`BLDGS.SIZE OF LOT NOW ON LOT CITY TEL. NOUSEOF
.BUILDINGS DISTRICT NO. GROUP MAP BY "
BK -PG.
CONTRACTOR ', Q/
D --.5
ADDRESS I ' CONNECTION DATA
CITY .,,TEL.NO/—�(Q!{Lpd ION DEPTH
.STATE MANHOLE REFERENCE
REGISTRATION N0. ® COUNTY / LOWER
No., DESCRIPTION OF R FEE
HOUSE SEWER CONNECTING TO. ` A�
. 'PUBLIC SEWER' @ $8.00l v TYPE OF CONNECTION LENGTH FRO 71
SEPTIC TANK,SEEPAGE PIT OR Y. UR . L: LEN TO P..L. Cl
PITS AND/OR DRAINFIELD @ $8.00
OVERFLOWSEEPAGEPIT,DRAINFIELD
EXTN:.CESSPOOL.DRYWELL @ $2.00 2 N0.
PRIVATE DISPOSAL SYSTEM @.$1.00 CO.IMP. NO.� _ . 70B N. ' � O
HOUSE SEWER CONNECTING TO - P C ,- CJ
-CONNECT-ADDITIONAL BLDG.OR
WORK TOMOUSE SEWER $1.00 @ - TRUNK PERMIT N0. ROAD PERMIT.NO.;- d''
- .
ALTER,REPAIR OR ABANDON'HOUSE - '- STATEENCROACHMENT O
SEWER OR DISPOSAL SYSTEM @ $1.00
PERMIT NO. CJ-
-
W
INDUSTRIAL -
WASTE APPROVAL
N
CHARGES Z
OWNER'S I PERMIT
.Z` 00 CONNECTION CHARGE FEE:
AUTHORIZATION FTOTAL FEE REIMBURSEMENT FEE
1,HAVE AT.THIS`DATE A CONTRACTWITH THE _HEREIN NAMED.CON-
TRACTOR 70 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTTOR'S SIC9NATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19 NEw.HDusE SEWER' f4 A
OWNER OR - _ CONNECT ADDITIONAL
OWNERS,AGENTS BUILDING OR-WORK
ADDRESS - SEPTIC TANK,SEEP..PIT(S) .
_ AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE'THAT t 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
1 HEREBY CERTIFY THAT 1 AM_'PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED.BY'LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT •1 AM THE LEGAL OWNER OF THE ABOVE -
DESCRIBED RESIDENTIAt PROPERTY. - BACKFILL SEPTIC TANKS ❑ ' - -
SIGNATURE SEEP.PIT(S ❑ CESSPOOL - - - -
OF PERMITTE Z aaadg2e
-�
VALIDATIO ROBE=RT A. WOOD
CK.. N.o. usx SUPERVISING MECHANICAL ENGINEER
3
76A64 '3
.• .IVI
APPLICATION .FOR PERIT�.• , .
76A 64 � �
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL-
DEPARTMENT OF COUNTY ENGINEER `
BUILDING AND SAFETY DIVISION BUILDING ``
JOHN A, LAMBIE, County Engineer." ADDRESS. Q/ P"/v
WILLIAM A.'JENSEN..Sup't of Building . LOCALITY C _
NEAREST
FOR APPLI ANT 'TO FQ:L IN CROSS ST.
LEGAL
DESCRIPTIONLOT NO-- OWNER e
BLOCKTRACT MAIL
o� ADDRESS
SIZE OF LOT .__Y� NOW N'LOT CITY_ ! TEL..NO '
USE,OF -
BUILDINGS _"l01 'DISTRICT NO. GR MAP -PROCESSED BY
iG
CONTRACTOR BX
ADDRESS' -5 CONNECTION DATA
CITY TEL.NO.A .a 4A Lod T- WTO N � DEPTH, �
7 STATE
REGISTRATION NO. e COUNTY MANHOLE REFERENCE LOWER
NO.. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO'
PUBLIC SEWER @ $B•00. TYPE'OF CONNECTION -LENGT FROM _
SEPTIC TANK,SEEPAGE PIT OR •Y. CURB P:L. M:L."TO P.L. O
PITS AND/OR.DRAINFIELD ' @ $8.00 -
OVERFLOW SEEPAGE PIT,DRAINFIELD ."C
EXTN..CESSPOOL:DRYWELL @ $2.00
' HOUSE SEWER CONNECTING TO P.C.•N0: 0
".PRIVATE DISPOSAL SYSTEM @ $1:00 CO.IMP:.N0. JOB NO. U
CONNECT ADDITIONAL'BLDG.OR' TRUNK PERMIT N0. ROAD PERMITNO.
WORK'TO HOUSE SEWER - @ $1.00 - g." 7
ALTER,'REPAIR OR ABANDON HOUSE STATE ENCROACHMENT O
.SEWER DISPOSALSYST M @ $1.00 'PERMIT U
- NO. - -
' INDUSTRIAL - -. LU
"WASTE APPROVAL
.•• - - - CHARGES - _ _Z _
OWNER'S-• PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION 1.TOTAL FEE "REIMBURSEMENT FEE.
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- - _ - -
TRACTOR TO CONNECT"THE'ABOVE DESCRIBED-EXISTING 'DWELLING APP.ROVAM DATE TN0ECTOR'SSIGNATURE
TO THE PUBLIC SEWER..
SIGNED THIS DAY OF 19_ NEW HOUSE-SEWER
OWNER OR - CONNECT ADDITIONAL' -
OWNERS AGENT ^e
�� • ,BUILDING.OR WORK.. -
ADDRESS - 'SEPTIC TANK,SEEP.PIT(S)� _
AND/OR DRAINFIELD -
I, HEREBY ACKNOWLEDGE THAT`F HAVE READ THIS APPLICATION '
AND STATE THAT THE ABOVE IS.CORRECT-CORRECT AND TO COMPLY, '.CESSPOOL-❑ DRYWELL ❑
.AND
COUNTY ORDINANCES AND STATE LAWS _REGULATING pLTERREPAIRSEWEROR
PLUMBING AND SEWERS.. - - -
'ALTER. , ,
SEWAGE DISPOSAL SYSTE -
-1 HEREBY CERTIFY THAT 1 AM. PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ''ABANDOWHOUSE SEWER. i "
CALIFORNIA OR THAT 1 AM" THE'LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTI RTY., BAC*SEEKFILLS ❑ CESSPOOLS
SIGNATURE --
OF PERMITTE ` h
- VALID'ATIO
ROBBRT A. WOOD
CK. M.0.' CAST! SUPERVISING MECHANICAL ENGINEER
.4
1.6t", JAN ?5 1 1 o ,? 5: 0 0 N