HomeMy Public PortalAbout5330 ARDEN DR_Sewer__ `24650INSE .
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COUNTY'OF LOS ANGELES SEWER-SEWAGE DISP®SAL
DEPARTMENT OF COUNTY ENGINEER .
BUILDING AND SAFETY DIVISION BUILDING A
ADDRESS'' 7;.-•s If _�,"
JOHN A. LAMBIE, County Engineer'
WILL A..JENSEN, Supt of Building. LOCALITY
.� .. _... - NEAREST • ' -� + ,- -
FOR APPLICANT TO FILL IN CRoss'ST.
LEGAL-
DESCRIPTION LOT NO OWNER CsCJ ;
� �. .,.MAIL
BLOCK. 'TRACT "�" •ADDRESS - r-
NO.OF BLDGS.
SIZE OF LOT, NOW ON LOT CITY TEL NO.. 61
USE OF - - ,t.,....,. .-
, .
BUILDINGS U DISTRICTNO. GROUP MAP ROC BY
BK PG I
CONTRACTOR
ADDRESS T CONNECTION DATA
CITY TEL.NO.,/_- /9 DEPTH
- - STATE °�MANHOLE REFERENCE• PE
'• -
REGISTRATION N0. d' � COUNTY
NO. -DESCRIRTION OF WORK FEE'
HOUSE SEWER CONNECTING TO 'ti-n
PUBLIC SEWER @ $3.00 0a TYPE OF,.CONNECTION LENGTH FROM
PETS AND OR PTIC NK,S EPAGELDT OR' - @ $3.00 Y. CURB - P.L. M.L.TO P.L..• Q -
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN..CESSPOOL:DRYWELL @ $2,00:-• 1 '
HOUSE SEWER CONNECTING TOP.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1,00 'CO.IMP. NO. •- JOB NO:
CONNECT-ADDITIONAL BLDG.OR TRUNK PERMIT NO. - BROAD PERMIT N0. O
WORK TO HOUSE SEWER @ $1.00 U
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT �.
SEWER OR DISPOSAL SYSTEM. - - @ $1.00' .PERMIT NO. _ O
c :INDUSTRIAL U -
WASTE APPROVAL 14
w
CHARGES.• - ,
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE -
AUTHORIZATION TOTAL FEE REIMBURSEMENT'FEE
- _1 HAVE AT THIS.DATE A CONTRACT WITH THE HEREIN NAMED.CON- c. _ _ - -
TRACTOR TO CONNECT THE ABOVE, DESCRIBED EXISTING DWELLING APPROVALS - DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. -
SIGNED THIS DAY OF 19 d -NEW HOUSE SEWER :
OWNER OR - CONNECT ADDITIONAL
OWNERSAGENTBUILDINGOR WORK - - _ -
., .ADDRESS SEPTIC'TANK•SEEP.PITS) '
AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT 'I HAVE READ THIS-APPLICATION -- - �• - '^- '• �• -` -
AND STATE _THAT THE ABOVE-IS CORRECT AND AGREE TO COMPLY CESSPOOL C) DRYWELL ❑ �.•
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING,AND SEWERS.- - - •v ..ALTER;REP.AIR,�SEWER OR --- - --- -• -• - c- -
I HER CERTIFY THAT I AM PROPERLY'REGISTERED AND/OR SEWAGE DISPOSALSYSTEM.
r' LICENSED. AS REQUIRED BY LOS ANGELES COUNTY -AND STATE=OF a .DISCONNECT.PLUG AND _
CALIFORNIA OR THAT I AM THE LEGAL OWNER. OF THE ABOVE ._
' -.ABANDON HOUSESEWER
-
DESCRIBED RESIDENTIAfl PROPERTY. BACKFILL SEPTIC TANKS ❑. -
SIGNATURE - - - - SEEP.PIT(S) ❑..CESSPOOLS_.❑
OF PERMITTEEatzedw,OFi
OF VALIDATIOW,. ) ROBERT A. WOOD ~
CK. m.o.. _ (CASH SUPERVISING MECHANICAL ENGINEEIt
L Ko 9, -5 l NOV 3 0 S:.G 0 � =
t� 24650 .INSERTS
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CE808 D .` A11 PL4��CATH®Ilii.. FOR PERMIT-.5, 3/ - --'
�easazn COUNTY OF LOS ANGELES" SEWER-SEWAGE MISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
- .. 'ADDRESS'. � r`f
JOHN A. LAMBIE, County Engiaeer
• WILLIAM A. JENSEN, Sup't of Building LOCALITY
.�:, ,��.. ,.NEAREST .c
FOR PPLICANT TO FILL IN "cRoss
'AST.
LEGAL
r DESCRIPTION LOT N0.
OWNER.—
TRACT 'MAIL
.;ADDRE
BLOCK SS Fr, i. . 1
.. NO.OF BLDGS..
SIZE OF LOT - NOW ON LOT 'CITY TEL. NO.
USE OF
BUILDING§ DISTRICT.NO. GROUPnF MAP PROCESS BY
BK PG r
CONTRACTOR - -Ai
a ADDRESS v —�" c - CONNECTION DATA
l CITY •- TEL.N0. aA Ga ON' DEPTH/45j_
STATE MANHOLE RE R E P
REGISTRATION NO. - �� GO -LJ COUNTY -
DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER- .@ $3.00 TYPE OF CONNECTION LENGTH FROM '• /
SEPTIC TANK,SEEPAGE PIT OR - CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD - @ $3.00
OVERFLOW.SEEPAGE PIT, DRAINFIELD- -
EXTN..CESSPOOL. DRYWELL @ $2.00 ,
'HOUSE SEWER CONNECTING TO - : P.C.N0
' . '
PRIVATE DISPOSAL'SYSTEM @.$1.00
CO.IMP. NO JOB NO..
• CONNECT ADDITIONAL BLDG:OR TRUNK PERMIT NO. ROAD PERMIT NO. �uG3 O
WORK TO HOUSE SEWER @ $1:00' i V,
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT- py
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. -
:INDUSTRIAL -
F'
WASTE APPROVAL W
- - J CHARGES - W
OWNER'S PERMIT $ AiCONNECTION CHARGE FEE
AUTHORIZATION' TOTAL FEE REIMBURSEMENT FEE ,
I HAVE AT THIS DATER CONTRACT WITH THE HEREIN NAMED CON- - - . `. ... '
TRACTOR TO CONNECT.THE ABOVE DESCRIBED.EXISTING DWELLING APPROVALS `•� DATE INSPECTOR'SSIGNATURE'
TO THE PUBLIC SEWER. - - - ��� � -
SIGNED TkIS DAY OF, 19_ NEW HOUSE SEWER'
OWNER OR - - CONNECT ADDITIONAL _AAx
' OWNERS'AGENT a,- BUILDING OR WORK. .._.• - .,� -SAM'" '' - - -
ADDRESS- SEPTIC TANK,SEEP.PIT(S) U�! ✓�
)' AND/OR DRAINFIELD.: .LI
I'HEREBY ACKNOWLEDGE THATI'-HAVE READ-THIS APPLICATION - -� - •- J� Y
(' AND STATE. THAT THE ABOVE IS CORRECT .AND 'AGREE TO COMPLY
CESSPOOL ,❑ DRYWELL ❑ i .
WITH ALL`,COUNTY ORDINANCES AND STATE- LAWS REGULATING
PLUMBING AND SEWERS. - - ALTER,-REPAIR.SEWER OR
SEWAGE
SEWAGE DISPOSAL SYSTEM
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 1 AM.THE LEGAL OWNER OF THE:ABOVE
DESCRIBED RESIDEN 1 PROPERTY. BACKFILL SEPTIC TANKS ❑ `
SE PIT(S)- ❑ CESSPOOLSSIGNATURE
.-
:OF PERMITTE
.a, -
J `
®" VALIDATION ROBERT A. WOOD
•; CIL - M.0.: _ Cases SUPERVISING_MECHANICAL:ENGINEER