HomeMy Public PortalAbout5140 ARDEN DR_Sewer__ DEPAI rMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY ; PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
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FOR APPLICANT T FILL IN LOCALITY
BUILDING NEAREST
ADDRESS �� �� y` CROSS ST. /"'c:!!-
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A
CROSS ST. l�C� I S
�/Cao S
•- / R CEIVED BY Ready for Inspection /fD•�AT/E ISSUED
OWNER (•, '� ! � � � eraPl- IMAIL
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ADDRESS �� �� �` USE ZBK ONE OCCUPANCY MAP
.J. ,��/���' '� PG
CITY i TEL.NO./-,..0� y 2- / . �, I 1 _ 'T
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CONTRACTOR �`�.( / i �r/�� CO.IMP.NO. f
ADDRESS! ,
JOB NO.
CITY�i2__ : �C60 TEL NO. /`i r✓ �✓�
TRUNK PERMIT N0.
.A'"
REGISTRATION N0. �J j g COUNTY ROAD PERMIT NO.
LEGAL .--
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT / Jf r7��C INDUSTRIAL
{ WASTE APPROVAL
SIZE OF LOTS � /3 NO.tIF BLDGS. �NOW ON LOT CHARGES
USEOF
BUILDINGS �'/!, �;`/� .�'J�/' � CONNECTION
CHARGE FEE
NO. - DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO I REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. I I ATE�I BY,
HOUSE SEWER CONNECTING TO i,'+f.
PRIVATE DISPOSAL SYSTEM IAO
CONNECT ADDITIONAL BLDft.OR isF� ''EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING / NO. DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 �I
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM . 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00
(CESSPOOL—DRYWELL STATION DEPTH
SPECIAL CONDITIONS ONLY 2.00p MANHOLE REFERENCE
4 UPPER s
-TYPE qF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y.
r'Ba��PcURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE 411.50 '' ' °"f�p'�y`
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED ^��-���• "�'���� �� `�/�ar "�
HAVE
TO CONNECT THE ABOVE DESC IBED EXISTING fAPPROVALS INSPECTOR'S SIGNATURE DATE /
DWELLING TO THE PUBLIC SEWER/f� " r^
...� >� (!ILL..
SIGNED THIS---''- .... .DAY OF �_..�:....-••-=••-•--19-•' = NEW HOUSE SEWER
OWNER OR �y CONNECT ADDITIONAL `
OWNERS AGENT......._.. ' 4/ _".-- -- '.\L :` �.....-- BUILDING OR WORK
ADDRESS. Cx -•••- SEPTIC TANK,SEEP.PIT(S)
- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL F] DRYWELL Ej
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCESAND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY. REGISTERED DISCONNECT PLUG.AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL,OWN-
ER OF THE ABOVE�D'E CRIl.)E ESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
�
/��% f SEEP.PIT(S)E] CESSPOOLS
SIGNATURE �fJ /, at/,
OF PERMITTEE--- ---- / ��� if ter/ -•----
76A642D 663 1/53