HomeMy Public PortalAbout5315, 5317 ARDEN DR_Sewer__ � D
6&E-669 12.54 APPLICATION' FOR PERMIT 1
6 Q E•8
DIVISION OF BUILDING. AND SAFETY SEWER—SEWAGE DISPOSAL.
` Department of County Engineer _
County of Los Angeles BUILDIADDREBU
SS0Vltll ��r
WM.J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY t v
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
_DESCRIPTION LOT NO. OWNER � d
BLOCK TRACT MAIL /
`� �j �( /� i' ADDRESS
SIZE OF LOT d 1�� hili' �/ NOW ON.LOTNO.
TEL.
USE OF
BUILDINGS ,� ,�,s��-� ,j i''�s7�-e". n DISTRICT O. GROUP MAP
BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY ' TEL. NO. STATION DEPTH
❑ STATE MANHOLE REFERENCE
REGISTRATION NO. ❑ COUNTY UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
/J CONNECT ADDITIONAL BLDG. OR
f/ WORK TO HOUSE SEWER 1.00 � 06 CO. IMP. N0. JOB. NO.
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO-,,,
DISCONNECT AND ABANDON SEWER STATE ENCROACHME T
AND/OR DISPOSAL SYSTEM 1.00 _. PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHAR FEE
OWNER'S PERMIT $ I o0
AUTHORIZATION TOTAL FEE � REI MBURSEM. NT FEEIHAVE 6 � 7t
CON-
TRACTORT HIS TO CONNECTDATEO THE ABOVE DESCRIBED EXISTINGWITH THE HEREINA DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF - 19- NEW HOUSE SEWER-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING ORR WORK
SEPTIC TANK, SEEP, PIT(S) r
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL ElAND STATE 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
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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS❑
` SEEP.PITS) ❑ CESSPOOLS❑
SIGNATURE ' ,.T� ,_ r!s
OF PERM ITT ( 1
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
nCo 6 4 4 5 AUG 9 4 2.0 0
' BY BY / _
DEPUTY DEPUTY
BY BY /-
® DEPUTY DEPUTY