HomeMy Public PortalAbout5311 ARDEN DR_Sewer__ DEPARTAfENT OF COUNTY ENGEVEM SEWER-SEWAGE DISPOSAL10,4 4
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER 1 BUILDING
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ADDRESS
FOR APPL CANT TOFI L IN LOCALITY
BUILDING`,%"y� / NEAREST
ADDRESS I_`S / / �f.� CROSS SL
LOCALITYP DISTRICT NO. SERIAL NO. PERMIT NO.
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NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATEISSUED
OWNER
MAIL 6
ADDRESS USE ZONE OCCUPANCY MAP
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CITY TEL.NO. — /- fc��,
CONTRACTOR California SewP.r nons% rGA_, CO.IMP.NO. IV:67
ADDRESS 1317 Colegroye Ave- JOB.NO. a�
CITY Montebello TELAO.UN1 017 1—F)04& TRUNK PERMIT NO.
STATE
REGISTRATION NO. 104445 S&q2&NTY ROAD PERMIT NO.
LEGALSTATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK / \ TRACT USTRIAL
WASTE APPROVAL
NO.OF
SIZE OF LOT 71,�Z'X 3 0D NOW ON LOTS I CHARGES
OF
BUIL DINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
D HOUSE SEWER CONNECTING TO /�
p PUBLIC SEWER @ $ 3.50 (/ RECEIPT NO/IDATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORD �
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING / I DATE �Y�
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00_ CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION /.�(p �I ® DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ry� .�le MANHHOLUBBE REFERENCE /U LOWER
r + =�yTYPE OF CONNECTION LENGTH FROM� !—
Y. CtTR6,;'_ ( P:L. M.L.TO P.L. 'P y(
;OWNERS PERMIT $ I 1 00 G
AUTHORIZATION I TOTAL FEE
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I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
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S16NED THIS - )AY OF---- - -<C_t !1J-----19S, NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL
ENT xBUILDING OR WORK
OWNERS AG - �.-•_----' --. 'C.. --•r ..
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.a�' .I..-----`b-!.-.L'...... .......CF. . ..........-'............. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ Till$ APPLI- CESSPOOL I-] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL.SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCR ED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS��
SIGNATURE SEEP.PIT(S) CESSPOOLS
OF PERMITTEE-- -- --s- L. -------...-v.---------- --------�
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