HomeMy Public PortalAbout5017 ARDEN DR_Sewer__ CEBOB-8•se APPLICATION FOR PERMIT
anoe-aCOUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER S�w��—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS - d7
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CASSATT D. GRIFFIN, Supt of Building LOCALITY
- NEAREST
FOR APPLICANT Tp FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT N0. OWNER s 4
BLOCK TRACT /715� MAIL
ADDRESS
N0.OF BLDGS.
SIZE OF LOT NOVGQU LOT CITY
USE OF
BUILDING DISTRICT NO. GROUP MAP PROCESSED BY
BK P6
CONTRAC
ADDRESS y j_ CO CTION DATA
CITY TEL.NO. ..y�^' STATION DEPTH
S ATE MANHOLE REFE NC UPPER
REGISTRATION NO. LOWER
No. DESCRIPTION'OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OFC NNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
D WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE C) REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS A/OF19 NEW HOUSE SEWER
LADDR
ER OR CONNECT ADDITIONAL
ERS AGENT BUILDING OR WORK 7
Loll SEPTIC TANK,SEEP,PIT(S)
ESS AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
STATE THAT THE ABOVE IS CORRECT AND AGREETO COMPLY CESSPOOL❑ DRYWELL❑
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
BING AND SEWERS. SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED D/OR DISCONNECT PLUG AND
NSED AS D BY LOS GE COUNTY AND TA E
FORNI OR THAT AM T E L.0 OF E AB E ANDONHOUSE SEWER
RIBED RESIDENTIA PROPBACKFILL SEPTIC TANKS❑ATUREEEP.PIT(S) ❑ CESSPOOLS❑PERMITTE
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®a AATION ROBERT A.WOOD
gy,, LIDm,pr egg SUPERVISING MECHANICAL ENGINEER
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27 10 A
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