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Home My Public Portal About5027 ARDEN DR_Sewer__ TEMPLE CUT 0 CESOB 8•B9 APPLICATION FOR PERMIT EBOB .• 7 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE. County Engineer CASSATT D. GRIFFIN, Supt of Duilding LOCALITY NEAREST FOR APPLICANT TO FILL IN ceoss sT. LEGAL ` � DESCRIPTION LOT N0. OWNER BLOCK TRACT /31 MAIL f ADDLES D NO.OF 9LDGS. SIZE OF LOT NOW ON LOT CITY TEL.. NO. USE D' I •. DISTRICT NO. GROUP MAP PRO SS Y BUILDINGS E.'SiL{ /VG r � �K_ CONTRACTOR il'^JI( r (/ ADDRESS CONNECTION DATA CITY TEL.NO. STATION DEPTH ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO. ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO ' _ PUBLIC SEWER @ $3.00 TYP OF CONNECT NLENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. .PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO. CONNECT ADDITIONAL '? WORK TO HOUSE SEWER @�81 00 00 TRUNK PERMIT NO. ROAD PERMIT NO. � ALTER,REPAIR OR ABANDONHOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $=i 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I 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 PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM 1 DISCONNECT PLUG AND HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT HOUSE D CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP RTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT(S ❑ CESSPOOLS ❑ OF PERM ITTE _ I ALIDATION ROBERT A. WOOD p� CK M.O. CASH SUPERVISING MECHANICAL ENGINEER 0554% JM21 10 ® 5.00- � . /� �- 76A6420 ' APPLICATION FOR PERMIT . 1 s g -66DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING ®. 7 l JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS a ® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS s. . LEGAL q 7 OWNER —DESCRIPTION LOT NO. c-4 .a je MAIL BLOCK TRACT ;� ADDRESS NO. OF BLDGS. CITY TEL. N0. SIZE OF LOT NOW ON LOT USE OF �^). f �• DISTRICT NO. GROUP MAP BUILDINGS 6, !L,�_-t 6;�. BK PG CONTRACTOR ✓ / ADDRESSYq CONNECTION DATA "�� C2. CITY -�,� TEL. NO. �� C� STATION I DEPTH W -MANHOLE REFERENCE UPPER STATE REGISTRATION 60. ` " ❑ COUNTY _ i No. DESCRIPTION OF WORK FEE - 0 TYPE OF ptCTION LENGTH FROM .�•� /"i HOUSE SEWER CONNECTING TO Y. C RB j P.L. M.L.TO P.L. PUBLIC SEWER @ $3.50 5*1 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 J OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO. f JOB N O EXTN.,CESSPOOL,DRYWELL,MANHOLE c@ $2.00. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. •' CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT . WORK TO HOUSE SEWER n $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNERS PERMIT 00 $ ' REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE 7 � I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCON- APPROVALS DATE INSPECTOR'SSIG •ATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER.. NEW HOUSE SEWERq SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER ORS / BUILDING OR WORK OWNERS AGENT �LN9%> (? SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ cO�� SIGNATURE SEEP. PIT(S) Ll CESSPOOLS & OF PERMITTEE JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A..WOOD, CHIEF PLBG. INSPECTOR CK. M.0. CAS L z '7 1 APR a . 4 A 4.5 0 . n .