HomeMy Public PortalAbout5128 ARDEN DR_Sewer__ 7(iA
E-6 83 11., 55 APPLICATION- FOR PERMIT , 1
8$E-8 '
DIVISION OF BUILDING AND SAFETY SEWER-SEWAE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING L— -7�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 22/
® CASSATT D. GRIFFIN., SUPT OF BUILDING LOCALITY
FOR APPLICANT TO F LIN _ceoss sTLEGAL
.,
-DESCRIPTION LOT NO.
J � 4;& I%_ _OWNERMAIL
BLOCK TRACTS ADDRESS OMII
3
NO. OF B DGS.
SIZE OF LOT NOW ON LOT CITY � TEL. NO �
USE OF DISTRICT N0. GROUP BK MAP PG
BUILDINGS �-�, _
CONTRACTOR
ADDRESS CONNECTION DATA
q` STATION �" b' [ DEPTH
CITY TEL NO. / / UPPER
� S . �/ MANHOLE REFERENCE
STATE .� y �__ P// LOWER
REGISTRATION NOj/ 9 ,f Z dg? ❑ COUNTY f'✓� 4 .A
NO. DESCRIPTION OF WORK FEE '
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD F.C. NO. IQ ..,fes
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO, IMP. NO. 10B NO.
HOUSE SEWER CONNECTING T0.
.PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. 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 $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL 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. NEW HOUSE SEWER y/i'S• mm21
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER ORa BUILDING OR WORK' -
OWNERS AGENT I _
-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 IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY 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 RESIDE IAL PROPERTY, BACKFILL SEPTIC TANKS F-)SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑ '
OF PERMITTEE ^
JOHN A. LAMBIE, COUNTY ENGINEER ALIDATION ROBERT,,A. WOOD, CHIEF PLEIG. INSPECTOR
CK. AA N.0, gg.�CAASH p�''.�yy� - - -