HomeMy Public PortalAbout5336 ARDEN DR_Sewer__ IDEPARTM3= OF COUNTS ENGDnmR, SEWER-SEWAGE DISPOSAL
9541
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING L+
ADDRESS
LOCALITY
FOR APPLICANT�jTO FILL IN _9-+�t./ C.�-��/,,
ADDREBUILDSS l /l ( � NEAREST
s F1�.I iCL�'` CROSS ST.
LOCALITY-�77®,9.,yl 149 r ' DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST 6� A l e( v- 6 S
CROSS S7.
/ RECEIVED BY Ready Inspection DATE ISSUED_
O W N E R (A .x /R 1 /1 L
MAIL USE ZONE OCCUPANCY MAP
ADDRE. o / I ^� BK PG
CITY
CITY TEEING. /J7/
CONTRACTOR California Sewer Const.Co. CO.IMP.NO.
ADDRESS 1317 . Colegroye Ave. JOB.NO. >.
CITY Montebello TEL.NO.UNlon 1-5048 TRUNK PERMIT NO.
TE
REGISTRATION NO. 10444'55 SSfll$$T_�ANTY ROAD PERMIT NO.LEGAL
DESCRIPTION LOT N0. ��0'02_ y U O STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT/� � I INDUSWASTAPPROVAL
SIZE OF LOT Y 'J NOW ON LOTNO.OFS l CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER aQ $ 3.50 RECEIPT N0.��I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
YlORK TO HOUSE SEWER 1.00 yyy
ALTER OR NO.REPAIR EXISTING I DATE �B
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 DEPTH
CESSPOOL—DRYWELL /
SPECIAL CONDITIONS ONLY 2.00I // / MANHOLE REFERENCE LOWER
TYPE OF CONNECTION--% LENGTH FROM
OWNERS PERMIT $ I 00 Y.-- -s�R_w P.L.) M.L.TO P.L. ��
AUTHORIZATION ( TOTAL FEE S75 —
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE-
DWELLING TO THE PU LIC SEWER l / L SIGNED THIS TPIIS..�Q._._ __.DAY OF
i� ,�1� 1910 NEW HOUSE SEWER ,r—AV'DG7�
OWNEROR CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT ... - >- S"a - �)
ADDRESS...............
- - -
_ !w�Q�. AND/OR DRAINFIELD SEPTIC TANKSEEP.PIT(S)
..�= Ft'
I. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-. CESSPOOL❑ 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_8YSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SIGNATURE e � /�/� SEEP.PIT(S)E] CESSPOOLS gy, S O C
OF PERMITTEE )^���///
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