HomeMy Public PortalAbout5317 ARDEN DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES qa
WILLIAM J. FCX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYBUILD
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NG NEAREST
ADDSS Z' CROSS ST.
LOCALITY DISTRICT No. A SERIAL Nd. PERMIT NO.
NEAREST A L $
f,ROSS SL_ . .,-RECEIVED BY Ready for Inspection DATE ISSUED
OWNER i
!Jv//%Y��'J, �`O - E
MAIL USE ZONE OCCUPANCY BK MAP
ADDRESS PG
CITY Y TEL NO. Q _ /
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CONTRACTOR CO.IMP.NO. A4
ADDRESS JOB.NO.
CITY1,, TEL.NO. Q. �❑ TRUNK PERMIT NO.
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REGISTRATION N0. 3- �" 7d� ___CONA,N:T_Yl ROAD PERMIT NO.
LEGAL �7
DESCRIPTION LOT NO. STATE ENCROACHMENT
O'er PERMIT NO.
BLOCK TRACT 79 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT
USE OF ��
BUILDINGS � « Ca-�t�s?���,K. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE - -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 LJ b RECEIPT NO. /DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING . NO. DATE BY
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/OR DRAINFIELD 2.00 STATION -� 67 DEPTH
CESSPO L—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 Cl,0/ MANNHOLLERREFERENCQ.D LOWER
TYPE OF CONNECTION /,LENGTH FROM
OWNERS PERMIT $ 1 00 -� P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 1
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER /
SIGNED THIS_.__!0..... OF......._...__..._..... 1q S NEW HOUSE SEWER ?�
�^ CONNECT ADDITIONAL
OWNER OR 1 � BUILDING OR WORK
OWNERSAGENT.................................................
Z SEPTIC TANK,SEEP.PIT(S)
ADDRESS..... .¢s_l._ ------ c»_._._.I -l-t!� .(In 4...!._... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E] DRYWELL[]
CATIONAND 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 IAM PROPERLY REGISTERED DISCONNECT
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
'ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE may.-•�O n✓ is SEEP.PIT(S) CESSPOOL ❑ ��
OF PERMITTEE..S2X._`_ _.. - - - - = � - '
76AG42A 663 7/53 C 77