HomeMy Public PortalAbout5231 ARDEN DR_Sewer__ _ C
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76AG42D APPLICATION
CO® PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 13UILDINc -9
JOHN A. LAMBIE, County Engineer ADDRESS _%
WILLIAM A. JENSEN, Sup't of Building y "
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS BT. �—
LEGAL �( //� — ['
DESCRIPTION LOT NO. 7;�.- 04
rr OWNER /� C �% (�y�
BLOCK TRACT H.ls•-C-Yl.f1 ADDRESS �..� Y�L7f' '/ a;
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITYTEL. .NO. �/j
USE OF DISTRICT NO. GROUP MAP .PROCESSED BY
BUILDINGS BJC PG
\ CONTRACTOR
ADDRESS .•� � ._ �!�• CO NECTION DATA -""":�"
CITY `- TEL. NO.- STATION DEPTH
❑ STATE UPPER
REGISTRATION NO. - ❑ COUNTY MANHOLE REFERENCE LOWER
No. DESCRIPTION OF WORK FEE -TYPE OFC N TION LENGTH d
HOUSE SEWER CONNECTING TO Y. UR .L:. M.L.
To
P.L. O
PUBLIC SEWER @ $5.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO. V
PITS AND OR DRAINFIELD @ $10.00 CO.IMP. NO.. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ S3.00 O
CONNECT ADDITIONAL BLDG.OR ,-AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR O. DATE 11J
WORK TO HOUSE SEWER @ $3.00 a
OVERFLOW SEEPAGE PIT,DRAINFIELD H
EXTN.,CES SPOOL,DRYWELL,MA NHOLE @ $5.00 Z
AC�RLTXc4R-0R ABANDON HOUSE p� HWY.OR ST.WIDENING
SEWER OR. GAI M @ S3.00 r _ STATE.ENCROACHMENT
PERMIT NO.
INDUSTRIAL ,
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00
CONNECTI
AUTHORIZATION TOTAL FEE t O CHARGE FEE
REIM RSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -
TO THE PUBLIC SEWER (/ APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 3 19
OWNER OR ��� NEW HOUSE SEWER -
OWNERS AGENT -
�y ��r ��y i CONNECT ADDITIONAL
ADDRESS f L. "C �i! BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGRE TO COMPLY
WITH ALL COUNTY, ORDINANCES AND STATE LAWS REGULATING -
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ '
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM Al.
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, ND INTEND TO
DISCONNECT PLUG AND 1-
OF
RESIDE IN, THE ABOVE_•eDFgSCR RES DEN AL OPERTY. ABANDON HOUSE SEWER f j +p A.SIGNATURE �f BACKFILLSEPTIC TANKS ❑ v-PERMITTEE SEEP,PITS) ❑ CESSPOOLS ❑E
VALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENGINEER
CK.
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76A642DAPPUGA 10 FO �p�q,�p�p�gppp -
CEBDB•8 � �k1;11:11V9IT
COUNTY OF LOS.ANGELES
r .,. SEWEF� : SE�le�GE ISP®SAI
DEPARTMENT,OF-COUNTY-ENGINEER'
BUILDING AND SAFETY.DIVISION ADD ElNG
I
SAD ESS
JOHN
A. LAMBIE County-Engineer
CASSATT D.:GRIFFIN ,Sup't'Of Building ' LOCALITY .
NEAREST
FOR APPLICANT-TO:TILL'IN N CRDss ST
-
LEGAL .• �;
DESCRIPTION, LOT NO OWNER
BLOCK. TRACT MAIL
-,.., ADDRESS /' .
NO:OF BLDGS.. ,_ _— _
SIZE OF LOT NO WON LOT --CITY
USE OF _ _- ._ : •. ^
BUILDINGS DISTRICT.NO. GROUP MAP* PROCESSED BY
BK PG '
CONTRACTOR t7 ,'
ADDRESS : 22,5 gtl.a,. Br' -aht"M'o• -Q• �^ - CO ECTI N ATA -
CITY El Monte TEL.N0, -GI 8-6'565' STATION; DEPTH �
O ]� / .
REGISTRATION'NO.. Fjn�7C}. ❑ ,COUNTY MANHOLE REFERENCE a UPPER.•
No. - —DESCRIPTION OF 0 FEE
HOUSE SEWER CONNECTING TO
-PUBLIC SEWER -' @'•$3.00 -
SEPTIC TANK,SEEPAGE PIT OR �) TYPE,OF CONNECTION - _ LENGTH FROM. .,.
'PITS AND/OR DRAINF.IELD ..-@ $3.00 - -'Y CURB P.L. M.L.,TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD'`
EXTN.,CESSPOOL,DRYWELL•MANHOLE. @ $2.00°
c `HOUSE SEWER CONNECTING TO P°.C.NO.
PRIVATE DISPOSALSYSTEM .@•.$1.00- _ _ CO-..IMP.'NO`. JOB NO.' ',I Q�w/•
CONNECT ADDITIONAL BLDG.OR`. TRUNK PERMIT NO- r ROAD,PERMI N0.6 -
WORKTO,HOUSESEWER @ .$i;00
ALTER,REPAIR OR ABANDON HOUSE - .. STATE ENCROACHMENT ° •-' -
` .SEWER ORDISPOSAL'SYSTEM.' @ '$1.00,. •' 'P.ERMIT•NW' '- -
''INDUSTRIAL; "
- _'WASTE'APPROVAL
— CHARGES- '
OWNERS PERMIT $ :: 2` 00 CONNECTION CHARGE-FEE
.,
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE •� r
I HAVE AT.THIS DATE 'A CONTRACT.WITH THE HEREIN-NAMED'CON:
TRACTOR TO CONNECT THE''ABOVE DESCRIBED EXISTING DWELLING PiPPROVALS ATE;I .,INSPECT.OWS;SIGNATURE
TO THE..PUBLIC SEWER.
NEW,HOUSE.SEWER � = 'mA
$16NED"THIS AY OF '' ]9- -^ � � •
:.;OWNER OR ° CON CTA - I A - •• `
NE DDIT ONAL K' "
OWNERS°AGENT ���� "BUILDING•`OR WORK-
TANK,SEEP,PIT(S) _
ADDRESS- -`" "' 'AND/ORDRAINFIEL•D ;
L'HEREBY.ACKNOWLEDGE'THAT,f-HAVE READ THIS:APPLICATION °
AND STATE THAT ,THE ABOVE-IS"CORRECT-AND AGREE TO,COMPLY `CESSPOOL'0-'DRYWELL❑ ^
WITH, ALL COUNTY ORDINANCES AND. STATE ,LAWS,REGULATING- ALTER','REPAIR;SEWER-OR
PLUMBING'AND SEWERS. SEWAGE-DISPOSAL-SYSTEM
1 HEREBY CERTIFY THAi'l 'AM:PROPERLY .REGISTERED AND/OR :DISCONNECT PLUG;AND A
LICENSED AS;;REQUIRED BY.LOS, ANGELES 000NTY,'AND.STATE OF
CALIFORNIA OR-THAT-I- AM THE LEGAL OWNER OF, -T ABOVE ABANDON HOUSE SEWER
DESCRIBED REST E TIAL PROP RTY. BACKFILL SEPTIC TANKS Q': L _
ti , `SEEP.PIT(S)'❑ CESSPOOLS
SIGNATURE ..� .. j .. ..�J
`OF PERMT,FY
®F _ ON, ROBERT.A WOOD
LIDATI
CK. H.o cases SUPERVISING MECHANICAL ENGINEER
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