HomeMy Public PortalAbout5143 ARDEN DR_Sewer__ 5&�E-663 11-55 /I--11Ptl LSBCATI®Ilv. FOR 9 PEtl UEW79I II - -
DIVISION OF BUILDING ARID SAFETY SEWER-SEWAGE D OSPOSA.L
Department of County Engineer .
County of LOS Angeles BUILDING S/ i� OC-��
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSAT,T D. GRIFFIN, SuP'T OF BUILDING { r
LOCALITY
FOR APPLIC NT TO-FILL IN CROSS ST.
120 5
-LEGAL
DESCRIPTION LOT N0. �• OWNER L! I617-T � CS<1 it/J-
A
-
BLOCK TRACT ADDRESS
>�13-c-) Ar - -JGt e7t-o .
NO.OF BLDGS.
SIZE OF LOT GX/INO.- ? ( 7
U CITY TEL.NOW ON LOT f., t�Lt ��
USE OF
BUILDINGSN0. .GROUP - MAP
BUILDINGS .�
CONTRACTOR All �1P
ADDRESS s�—/. 'CONNECTION•DATA
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STATION :, S o . DEPTH
CITY � TEL. NO.
��1�` d'�' �• MANHOLE REFERENCE
TE
REGISTRATION NO. / � '� _ COUNTY
NO. DESCRIPTION OF WORK FEE
,HOUSE SEWER CONNECTINGTO TYPE OF CONNECTION, LENGTH FROM_
PUBLIC SEWER @ $ 3.50 �� CURB P.L. M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD. @ $3.00 /•
OVERFLOW SEEPAGE PIT,DRAINFIELD • CO. IMP. N0. p .NOOC.
ERTN.,CESSPOOL,DRYWEL'L,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1:00 �. TRUNK PERMIT N0. ROAD PERMIT NO. X37
' 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 Y-6-
` 1 HAVE AT THIS DATE ACONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE -ABOVE DESCRIBED E (STING DWELLING
TO.THE PUBLI s - -NEW HOUSE SEWER e f G _✓7,
SIGNED THIS DAY OF 11 CONNECT ADDITIONAL
OWNER OR • _ BUILDING OR WORK -
OWNERS AG SEPTIC TANK,SEEP,PITS)
,ADD RES AND/OR DRAINFIELD -
I HE BY AC OWL GE THAT 1 HAVE READ THIS APPLICATIONCESSPOOL❑ DRYW ELL❑
AND STATE AT 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' _
I 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 1 AM THE LEGAL O� R. OF THE ABOVE ._
DESCRIBED RESIDENTIAL PROP RTY. BACKFILL SEPTIC TANKS.❑
SIGNATURE
SEEP.PIT(S) ❑ CESSPOOLS❑'
OF PERMITTEE
JOHN A'. LAM E,COuN ENGINEER LIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR'
CK. M.0. CASH -
2 g' 5 2 APR 14. 4 A 4-50-A