HomeMy Public PortalAbout5155 ARDEN DR_Sewer__ - \1
S . 4rD63 ii-555
S.& � - APPLICATION FOR PERMIT. 1
.h E-6DIVISION OF BUILDING AND,SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITYNEAREST
A
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER I
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS. CITY `_ �y 'TEL. NO. 1
SIZE OF LOT - v NOW ON LOT l'
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
.f
G
CONTRACTOR
ADDRESS /�e.� �?( CCONNECTION DATA
CITY � ��.®r TEL. N0. ¢ �'� STATION (� S DEPTH °.
MANHOLE REFERENCE UPPER
[3;�ATE .o LOWER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO `� PE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0. I Q J -
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO. IMP. NO.
HOUSE SEWER CONNECTING TO 3-36
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT N0. ROAD PERMIT NO.
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
OWNERS PERMIT $ 11 00
AUTHORIZATION TOTAL FEE r REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HE IN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED WtTING DWELLIN
TO THE PUBLICSE,, ER. NEW HOUSE SEWER
_ .0
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGEN _.L'
SEPTIC TANK,SEEP,PIT(S)
71?
ADDRESS AND/OR DRAINFIELD
I HE BY YNSTY
OWL E THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND S ATE TH ABOVE IS CORRECT AND AGREE TO COMPLY
WITH L RDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AEWERS. 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 OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL DCOPERTY. BACKFILL SEPTIC TANKS❑ '
SIGNATURE
SEEP. PIT(S) ❑ CESSPOOLS'❑
OF PERMITTEE -
JOHN A. LAMBIE. COU TY ENGINEERA DATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CK. VM.0. CASH -
� 1�2 8 5 41 APR 14 4 1 4050