HomeMy Public PortalAbout5327 ARDEN DR_Sewer__ $&E•H63�11.55 AP UCATT OII W' ®� �� �.HVtl �. U. _
'DIVISION OF BUILDING-AND SAFETY -SEWER—SSWAG .MspoSAL.
Deportment of-County Engineer. '° f'
' County of LOS Angeles BUILDING
JOHN A.-LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS S'.
LEGAL - ` - OWNER - a' r
DESCRIPTION ,LOT N0, I,+ *7 /J
BLOCK I TRACT- ! / O ADDRESS 3�J `��' _
'NO, OF BLDGS. CITY TEL.'NO
SIZE OF LOT _ NOW ON LOT paG a 04 Q o /
USE OF ` - DISTRICT NO. GROUP - - MAP
- BUILDINGS ♦ �C.�Qi BK - PG
CONTRACTORor
ADDRESS
CONNECTION DATA
�� � � /� �p - -
CITY TEL, N0. 0� CFO �y -STATION DEPTH. &IS
.. J MANHOLE REFERENCE, UPPER
❑ STATE ti
REGISTRATION NO, .//36/�,.�,�� .n�evv,^^"`,'-Tg -
NO'" DESCRIPTION OF WORK FEE -
TYPE OF"CONNECTION�--� LENGTH FROM
HOUSE SEWER-CONNECTING TO Y. CURB /r•L• J M.L.TO P.L.
PUBLIC SEWER @ $'3.50 -
SEPTIC TANK,SEEPAGE PIT OR .. _
PITS AND/OR"DRAINFIELD @ $3.00 -
OVERFLOW SEEPAGE PIT,DRAINFIELDP. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $ 2.00. _ CO._'IMP.'NO. / � JOB'NO: '
- HOUSE.SEWER-CONNECTING TO- -
PRIVATE DISPOSAL SYSTEM Q $1.00 - - TRUNK PERMIT'NO. -- -- ROAD PERMIT N0: -•--
CONNECT ADDITIONAL BLDG.ORSTATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO. -
ALTER REPAIR OR ABANDON HOUSE - INDUSTRIAL •• - -
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL -
- ' CHARGES
CONNECTION.CHAR_GE FEE - -
OWNER'S ` PERMIT• $ 1 00
REIMBURSEMENT FEE - -
AUTHORIZATION TOTAL FEE
I HAVE'AT THIS DATE,A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE' INS PECTOR'S SIGNATURE
TRACTOR TOCONNECTTHE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC S�EWaER. � - // NEW HOUSE SEWER
SIGNED THIS— DAY O 790 CONNECT ADDITIONAL
OWNER. .OR .'/ BUILDING OR WORK _ -
OWNERS AGENT SEPTIC TANK,.SE EP, PIT(S) `
ADDRESS AND/OR DRAINFIELD' - - -"
I HEREBY AC NOWLEDGE THAT I HAVE READ-THIS APPLICATION CESSPOOL❑ DRYWELL.❑ -
AND 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 -
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR w DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND'STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE-LEGAL 0 R' OF.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑'.
SIGNATURE SEEP. PIT(S) [],,CESSPOOLS(D -
OF PERMITTE
`JOHN A. LAMB.IE, COUNTY ENGINE VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
ScK. N. O. CASH .
! 4631x° APR ?.. 4• . 5.50 �, "