The URL can be used to link to this page

Home My Public Portal About5412 ARDEN DR_Sewer__ CE8083i62 APPLICATION FOR PERMIT 76A642D u COUNTY OF LOS ANGELES SEWER-SEWAGE DIS` OSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONBUILDING f.—,/,/!�/ p_ JOHN A. LAMBIE. COUNTY ENGINEER ADDREss tJ >1'COLEMAN W.W. JENKINS. SUPT. OF BUILDING ' LOCALITY NEAREST FOR APPLICANT TO FILL IN CRD55 5T. LEGAL DESCRIPTION LOT N .��'_ ,(�j � OWNER / MAIL BLOCK TRACT �� _ /� -y "� GG ADDRESS 3 5C NO. OF BLDGS. `� SIZE OF LOT NOW ON LOT CITY • TEL. NO. tJ USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRALTO �Cr�►"+ � V P / ADDRESS Y 4 CONNECTION DATA CITY TEL. N Q 8 $' STATION DEPTH STATELIC r'n` / MANHOLE REFERENCE UPPER LICENSE NO:, �O3 CLA'SS� Y" V f NO. .DESCRIPTION OF WORK' FEE TYPE OF CONNECTION LENGTH FROM } HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. d PUBLIC SEWER @ $5.00 P.C.NO. O SEPTIC TANK,SEEPAGE PIT OR JOB NO. (,J PITS AND/OR DRAINFIELD @ $10.00 CO. IMP. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL BLDG.OR ,per') AFFIDAVIT walvEx EaS EMEN• RECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 W OVERFLOW SEEPAGE PIT,DRAINFIELD a EXTN..CESSPOOL.DRYWELL.MANHOLE C $5.00 V) ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT ^ PERMIT NO. („ INDUSTRIAL WASTE APPROVAL L OWNER'S PERMIT $ z Oo CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE _ IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLISEWER. APPROVALS D TE I S CTOR' SIG ATURE SIGNED THIS-DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREB TIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICEN5AS R UI BY ANGLES COUN STAT OF SEWAGE DISPOSAL SYSTEM CALIF RN OR H AM HE L GAL OW NE F. AND! INTEN TO DISCONNECT PLUG AND RESI E I H OWE D CRIBE RES EN L PROP T ABANDON HOUSE SEWER SIG R a BACKFILL SEPTIC TANKS ElF tT P.PIT IS) ❑ CESSPOOLS ❑ V LIDATIOJACK R. ALLEN SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH �� 9 0 3 6-D' N227 1 0 n 5.00 CITY OF TEMPLE CITY CE808 5-65 7bA642D APPLICATION FOR PERMIT - COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION a BUILDING 'L A.�� JOHN A. LAMBIE, County Engineer ADDRESS N( �/ COLF.NU\N W. JH NKINS,Sup't. of Building /�(a /�/ ' LOCALITY `j L C/ / `, J FOR APPLICANT TO FILL IN NEARESST. LEGAL �^ ,p•A DESCRIPTION LOT NO. /�' OWNER L'A �� J T H MAIL _ /� /r��t,/ �/ e7 BLOCK TRACT ADDRESS Fi>> �/iV�/V �C/�/"/(��/ SIZE OF LOT Y f J NOWON LOT CITY 9 7 v j EL. NO. J USE OF BUILDINGS DISTRICT NO. GROUP MAP P OC ESSED BY G� - CONTRACTOR -ytA� / ADDRESS to W CONNECTION DATA SQ CITY TEL. NO. STATION DEPTH LICENSE LICENSE ""PBR_ NO. CLASS MANHOLE REFERENCE LOWER NO. DESCRIPTION OF WORK FEEY. CTYPE OF CONNECTION LENGTH FROM Q HOUSE SEWER CONNECTING TO URB P.L. M.L.TO P.L. J�� PUBLIC SEWER C $ 5.00 - } SEPTIC TANK, SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD C $1 0.00 CO.IMP.NO., `a JOB NO. O HOUSE SEWER CONNECTING TOTRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM C $ 3.00 CONNECT ADDITIONAL BLDG. OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE O WORK TO HOUSE SEWER C=' $ 3.00 OR ABANDON HOUSE ® V SEWER.OR SYSTEM C $ 3.00 6. N E%T N.,CESS POO L, MANHOLE HWY.OR ST.WIDENING @ $ 5.00 STATE ENCROACHMENT PERCOLATION TEST @ $ 5.OG } PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT a 2 00 ' AUTHORIZATION TOTAL FEE 1 016 CONNECTION CHARGE FEE 'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY O.F 19_OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK..SEEP,PIT(S) I HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD ' AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDVOR ALTER.REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM A CALIFORNIA OR THA I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A E DESCRIBED RES D N L - OPERTY. ABANDON HOUSE SEWER SIGNATURE ❑ - - OF PERM BACKFILL SEPTIC TANKS SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK. M.O. CASH ' _ 76A642D C®®TI®'N , m®R PERMIT A ER ® ITAPLI - y E•663 12.54 , DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D9SPOSAL Department of County Engineer County of Los Angeles r_LR_DR ,/ ;j WM. J. FOX, COUNTY ENGINEER 'J� b CASSATT D. GRIFFIN,'SUP'T'OF BUILDING � /,, FOR APPLICANT TO.FILL IN c"aoss sr. 7TEL. LEGALDESCRIPTION LOTNO.BLOCKr _ _ MAIL /ADDRESS !OSIZE OF LOT NOW ON LOT . ,{�jJ "� CT _ USE OF• - BUILDINGS DISTRICT NO. GROUP MAP K PG CONTRACTOR i ADDRESS CONNECTION DATA ' CITY' TEL. NO. STATION f^'� DEPTH Yvj STATE / O MANHOLE REFERENCE REGISTRATION NO. / �j/� � .I COUNTY— �,<U/ D L,�/. UZZLI LOWER TYPE OF-CONNECTION LENGTH FROM NO. DESCRIPTION OF WORK FEE -Y• c"°36 ,p„L-m M.L.TO P.L. 'HOUSE SEWER CONNECTING TO b�. `— '.S- !' •PUBLIC SEWER _ a $ 3.50. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ' - 1.00 _ :CONNECT ADDITIONAL SEW CO. .BLDG. OR IMPNOJOB. NO. ' WORK TO HOUSE SEWER 1.00 - —ALTER OR REPAIR EXISTING 0' SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO:.' ROAD PERMIT N0. .DISCONNECTAND ABANDON'SEWER ENCROACHMENT 'AND/OR DISPOSAL SYSTEM 1.00 SSTATTATE EERM NO. SEPTIC TANK, SEEPAGE PIT.OR PITS AND/OR DRAINFIELD 2.00 . INDUSTRIAL CESSPOOL- DRYWELL - WASTE APPROVAL ;SPECIAL CONDITIONS ONLY. -' 2.00. CHARGES - pEP.A?IT CONNECTION CHARGE FEE, OWNER'S S 1 00 ` AUTHORIZATION"— TOTAL FEE' - REIMBURSEMENT FEE I HAVE,THIS.DATE .CONTRACTED'WITH THE HEREIN NAMED CON- " TRACTOR TO .CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER- ? NEW HOUSE SEWER' SIGNED THIS DAY OF 1, 9__2_1_Q OWNER- - ORJ CONNECT ADDITIONAL. `' OWNERS AGENT f " G�-r✓2+C, 1�e BUILDING OR WORK - SEPTdGTANK, SEEP, PIT(S) _ADDRESS :. .✓_ '' - - - }/_i � (( AND/OR-DRAINFIELD ' .1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ATI N CESSPOOL'❑ DRYWELL.C] AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY U ' - WITH ALL COUNTY ORDINANCES AND"STATE LAWS- REGLATI G ALTER, REPAIR,SEWER OR - PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY-CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND _ LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA-OR- THAT. 1 AM THE LEGAL -OWNER OF THE' ABOVE DESCRIBED RESIDENT OPERTY. BACKFILL SEPTIC TANKS❑ _ SEEP.PIT(S) El-CESSPOOLS❑ ' .SIGNATURE OF PERMITTEE - a NEMERES j I - WILLIAM J. FOX, COUNTY EN EER VALIDATION BY -- � 0 5 By 6 1 JUL 1.3 4 4.5 DEPUTY •� - _DEPUTY -.,BY 4 BY x® E DEPUTY DEPUTY