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HomeMy Public PortalAbout5133 ARDEN DR_Sewer__ 76A 642D - CE808 - 9/73 APPLICATION FOR PERMIT r COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS / r LOCALITY w P NEAREST FOR APPLICANT TO FILL IN ROSS ST. LEGAL �{�.(� DESCRIPTION LOT NO. OWNER ©,r �" -A DESCRIPTION q MAIL BLOCK TRAJ�M 6-- 41 ADDRESS ( /" E _` NO. OF BLDGS. ♦ J/ �7 SIZE OF LOT NOW ON LOT CITY {� TEL. NO. OF BUILDINGS DISTRICT N0. GROUP MAP qCj!BY .tl r( 1BK PG CONTRACTOR 24(/"" z-' "" z-' c v . 6 - •� ��.�. ADDRESS Q O,Y" CONNECTION DATAyyy Lj CITY TEL. NO. � STATION0„, DEPTH STATE rI I' / LIC /� L MANHOLE REFERENCE67-0 /� , UPPER LICENSE NO;. f'CJ {/l OLA55 V�O OWE NO. DESCRIPTION OF WORK FEETYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR CO.IMP.NO. JOB NO. PITS AND/OR DRAINFIELD $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO '� PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 1 OVERFLOW SEEPAGE PIT.DRAINFIELD c:) EXT N..CESSPOOL.DRYW ELL. @ $5.00 V HWY.OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE 0 SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT (--- MANHOLE Q $7.00 PERMIT NO. W INDUSTRIAL a WASTE APPROVAL CHARGES - OWNERS PERMIT S o AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ ' OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LCALIF G AND SEWERS. CESSPOOL ❑ DRYWELL ❑ BY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM 1A OR THAT M TH EGAL OWNER OF. AND INTEND TO - ISCONNECT PLUG AND N, THE A ESC EO RESID NTIAL PROPERTY. ABANDON HOUSE SEWER RE BACKFILL SEPTIC TANKS ❑MTTTEE SEEP.PIT(S) ❑ SPOOLS ❑ VALIDATION CK. M.O. CASH J 0 3 7 cr--NT 29 1 u U 1 5.0 0 ���