HomeMy Public PortalAbout5342 ARDEN DR_Sewer__ DEPAKIMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
fi DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDI
ADDRESS
NG FOR
�G 354
FOR PPL�IFlCANT TO ILL IN LOCALITY
BUILDING 52 NEAREST
ADDRESS T— CROSS ST.
LOCALITY r , DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST. A JU O 54 '— S
CROSS ST. 1p, 00A REC IVEEDDBYee Ready for Inspection DATE ISSUED
/
OWNER • l
MAIL
ADDRESS 0 USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO. / I '�d
CONTRACTOR _ 4 /
CO.IMP.NO. O
ADDRESS 1i JOB N0.
CITY TEL.N( h 6,0TRUNK PERMIT N0.
•tea ❑ STATE
REGISTRATION NO.J A 4 L/ ❑ COUNTY ROAD PERMIT NO.
LEGAL r
DESCRIPTION LOT NO. STATE ENCROACHMENT L�2• ��
e rA _ PERMIT NO.
BLOCK 1-3 TRACT / I/ �� �•D INDUST APPROVAL
SIZE OF 1-0196 NOW O.OF BLOGS.
ON LOT ' CHARGES
¢Ji NV
USE OF n
BUILDINGS �.•C� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE- - (BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR 006EPTION RECORD D�
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. 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 (�'I �� d DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE
/ lINN LOWER
TYPE OF CONNECTIONLENGTH FROM /
OWNERS PERMIT $ 1 00 C"'w" P.L M.L.TO P.L. O
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF........___-..._..._.....__........19__ NEW HOUSE SEWER � IOC z/-gi S-,-
OWNER CONNECT OWNERS AGENT _ 4y.. _ BUILDING OR WORK
OWNERS
r• � n!e
SEPTIC TANK,SEEP.PIT(S)
ADDRESS_�_ �e�...(.. _ .,y_ ... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGETT AT 1 HAVE READ THIS APPLI- CESSPOOL I] DRYWELL El
CAT
IONAND STATE THAT TH 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 i 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 D SCRIBE RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS
�
SIGNATURE _ SEEP.PIT(S)E] CESSPOOLS a�
OF PERMITTEE _ ___ � _- ... .._.. _
�•......_....._.
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