HomeMy Public PortalAbout5013 ARDEN DR_Sewer__ DEPAR.TIMENT OF COUNTY F�NGDMM SEWER-SEWAGE DISPOSAL
'DIVISION OF BUILDING AND SAFETY
PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING �O) /i '
I ADDRESS /�
FOR APPLICANT TO FILL IBUILDING �N1 LOCALITY
ADDRESS �pUy� NEAREST I e r A ? 160a �
A6 CROSS ST.
LOCALITYTC DISTRICT NO. SERIAL NO. PERMIT NO.__5A 3�l � �- s
NEAREST 9
CROSS ST. W.0/9 I�/�c/.Ss$
� jtRECE�IjVE`D".'BY(p) Ready for Inspection DATEISSUED
OWNER P /rr
ADDRESS MAIL USE IONS OCCUPANCY BK MAP PG
CITY TELAO. 4 (/ 1
CONTRACTORyF A(. c 357ao� S�IC re SV CO.IMP.NO.
ADDRESS Alko 7 /0 I e_e x w V'
JOB.N0.
CITY �d�M�LL•- (��-toe TEL.NO. �tT 7 d-p7-" TRUNK PERMIT NO.
TE
REGISTRATION NO. l f/G® 7 G ROAD PERMIT NO.
LEGAL. 'l STATE ENCROACHMENT
DESCRIPTION LOT NO. ,� 7 PERMIT NO. ='
BLOCK TRACT ` �� INDUSTRIAL
WASTE APPROVAL
NO.OF
SIZE OF LOTS NOW ON LOTS / CHARGESUSE OF
--"
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEEj'
HOUSE SEWER CONNECTING TO REIMBURSEMENT FLEE
PUBLIC SEWER @ $ 3.50 '5-0 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 Loo CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR 9 � 2 7. DEPTH 4 ^�
PITS AND/OR GRAINFIELD 2.00 STATION 54.
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �S�} - S' f,MA!",OLE LOWER
TYPE OF CO�NNNECTIONs LENGTH FROM
Y M.L.TO P.L.
OWNERS PERMIT $ I I 00 CURB L�P.L.
AUTHORIZATION I TOTAL FEE 'el 0
IHAVE N NAED
CONTRACTOIR TO CONNECT THS DATE TE ABOVE DESCRIBEDED WITH THE EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS...1.6........DAY NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL
OWNERS AGENT6_-
_ - BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS .... If - - -- -........ -. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CA
TIONAND 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND
DISCONNECT PLUG A
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUG ND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPE BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)El-CESSPOOLS[:j
/���
OF PERMITTEE.. -_ -- .'----- --- .---- ---_- t
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76A642A 663 7/53 v(l�P