HomeMy Public PortalAbout5149 ARDEN DR_Sewer__ S xes 11-5- APPLICATION FOR PERMIT 1
DV ),N OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
epostment of County Engineer
County of Los Angeles BUILDI
ADDRESSNG f
JOHN A. LAMBIE, COUNTY ENGINEER �<L
T) CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER +
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT ADDRESS 6- v �•.
SIZE OF LOT ® NOWOON LOTS i CITY 71 e TEL. NO. f
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
CONTRACTOR
A K �P�
ADDRESS A , V�.2 CONNEECCTION DATAJJ
CITY �` TE . STATION DEPTH
LN
`L MANHOLE REFERENCE UPPE
C-STATE LOWER
' REGISTRATION N0. /� ❑ COUNTY /
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO lerYPE 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 Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD - CO. IMP. N0. JOB NO
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 7 15'4
1 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�SEWE
4 OF NEW HOUSE SEWER
SIGNED THIS DAY 9 19 �
• CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AG SEPTIC TANK,SEEP,_PIT(S)
ADDRESS AND/OR DRAINFIELD
I HE EBY AC OWL GE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL El
AN
S&kTE 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
1 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 I THE LEGAL NER OF THE ABOVE
DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE.CO TY ENGINEER LIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. M.O. CASH 2 �
"� 02956.� RR 14 . 4 A �.5 � to