HomeMy Public PortalAbout5324 ARDEN DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER t -SEWER-SEWAGE, DISPOSAL
DIVISION OF BUILDING AND SAFETY _ PERMIT APPLICATION
COUNTY OF LOS ANGELES /�
WILLIAM J. FOX, COUNTY ENGINEER ill BUDRESSILDING A,c-6 1
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FOR APPLICANT TO FILL- IN t LOCALITYBUILDING /
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ADDRESS SST. C� ve of TS•
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LOCALITY T� (��� m�j c y I DISTRICT N0. SERIAL N0. + Q PERMIT NO. c
NEAREST r���(/1 ( �! /�1 V' :' 1 v A
CROSS ST: p 1� p RECEIVED BY Ready for Inspection ,DATE ISS ED
OWNER J L � �Id`��JA f?_r� L 41 C? 67 po ,��jra �(�- lS�
MAIL c ZONE OCCUPANCY MAP
ADDRESS V � dL(� �/A 05 b Z/l bR 1 USE _ BK PG
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CITY i ,M 017 �/ TEL.NO. 1'y p �?S
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CONTRACTOR 3/� '/��l�S'6�/G i CO.IMP.NO.
ADDRESSJJ/� JOB N0.
CITY hs;��yr TELAO. �T y-rJI� TRUNK PERMIT NO.
REGISTRATION NO. /9 �I ®COUNTY. ROAD PERMIT NO.
!-
LEGAL STATE ENCROACHMENT _
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRADUSTRIAL
.FT L G C/ WASTEAPPROVAL �-
SIZE OF LOT G NOW ON LOTS l - CHARGES
USE OF d��Sx N C "
BUILDINGS CONNECTION C E FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO /
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DA 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. I DATE I 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 274/ / DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MA HAlE REFERENCE
/O / i. . ITP C .W.ER'
TYPE OF CONNECTIQl+I�� LENGTH FROM // /
OWNERS PERMIr $ 1 00 B' P.L. M.-L.TO P.L. Q_
AUTHORIZATION TOTAL FEE -!� �
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECT OR'SSIGNATURE DATE
DWELLING TO THE PUBLIC'SEWER c
SIGNED THIS-----------------__DAY;OF------ 'U ----------------19,7.3 NEW HOUSE SEWER Sr. rock
OWNER 'OR ( CONNECT ADDITIONAL
OWNERS ANTI ..._ _ BUILDING OR WORK
ADDRESS: ?_- - ... SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVEAEAD THIS APPLI. CESSPOOL I] DRYWELL
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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN=
ER OF THE ABOVE DESCRIBED IDENTIAL•PROPERTY.' BACKFILL SEPTIC TANKS
SIGNATURE ` 11
,,//yy SEEP.PIT(S)El CESSPOOLS[a- j A-�a' S
OF PERMITTEE___ _____ __.. - _:1��_Te�fF ._.......
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