HomeMy Public PortalAbout5124 ARDEN DR_Sewer__ &EE-6D69 i1-55
!3& -6APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
4 Department of County Engineer
o County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILOING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL - OWNER
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT ADDRESS *�
OF BLDGS. CITY TEL. NO.
SSIZE OF LOT WON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PG
CONTRACTOR 7- 2—
c4
— Zc4 ADDRESS 1S '-��,/ �� CONNECTION DATA
ZO
r� 7 4 STATION DEPTH g
CITY MMATEL. N0. MANHOLE REFERENCE UP
❑ STATE OWER
REGISTRATION NO.yf kS COUNTY
NO. DESCRIPTION OF WORK FEE
YPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 U
HOUSE SEWER CONNECTING TO 1 y- CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR ..
PITS AND/OR DRAINFIELD - @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYW ELL,MANHOLE @ $2.00 ' CO. IMP. NO. -ma Nn pit 7�
HOUSE SEWER CONNECTING TO .� �� � 2
PRIVATE DISPOSAL SYSTEM @ $1.00 t TRUNK PERMIT N0. ROAD PERMIT NO. !�
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT —�
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
J AUTHORIZATION I TOTAL FEE
'sv
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING y'
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS _ 19 CONNECT ADDITIONAL
OWNER OR —' BUILDING OR WORK
OWNERS AGENT!C SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANG S COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I THE G OWNER OF THE ABOVE _
DESCRIBED RESI DENTIA OPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) ❑-CESSPOOLS❑
OF PERMITTEE
JOHN A. LA IE, OUNTY ENGINEER LIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.O. CASH
D.C' 846OR APR 14 . 4 A 4-.50 Q1