HomeMy Public PortalAbout5420 ARDEN DR_Sewer__ E.663
S&E•863 11.55 APPLICATION FOR PERMIT 1
8&E
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING � �
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS %�( a
® CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITYNEAREST
'g
FOR APPLICALLNT TO FILL IN CROSS ST.LEGAL
/
—DESCRIPTION LOT NO. J�, /V 5T OWNER
MAIL
BLOCK TRACT ADDRESS� ��'�
r� N0. OF BLDGS. CITY TEL. NO.
SIZE OF LOT ./� /` r. NOW ON LOT
USE OF i
BUILDINGS DISTRICT NO. GROUP MAP
�q 11 BK PG
CONTRACTOR Vr ,1 N
ADDRESS CONNECTION DATA
/ � . STATION DEPTH `
CITY TEL. NO, -4e MANHOLE REFERENCE i UPPER
_
ESTATE
REGISTRATIO NO Z, ❑ COUNTY
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTI LENGTH FROM O
HOUSE SEWER CONNECTING TO Y. CURB P.L. y M.L.TO P.L.
PUBLIC SEWER @ $ 3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD a $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELDP. C. NO,
EXTN.,CESSPOOL,DRYWELL,MANHOLE Qi $2,.00 CO. IMP. N0, [' ,Q JOB NO.
HOUSE SEWER CONNECTING T.0
PRIVATE DISPOSAL SYSTEM a $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT ..
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
s SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARG
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE '
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE'
TRACTOR TO CONNE S�THf ABOVE DESCRI D EXISTING DWELLING -,
TO THE PUBLIC S�EW�Ey NEW HOUSE SEWER
SIGNED THIS—L�DAY OF 19 CONNECT ADDITIONAL
OWNER OR 7 BUILDING OR WORK
OWNERS AGENT /^ /'•
ADDRESS.;? 2rJ (, lL _�!. - 'iAND/OIEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION •CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I ,H/F�/EOREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
L171 ED AS R QUIRE 19 LOS ELES C TY AN T F
CA Rj11.W4 0 HA• AM TH EG OF ABANDON HOUSE SEWER
D I D I E D J o BACKFILL SEPTIC TANKS❑
S N TURE (/fjd/ SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITTEE ��� ( '
JOHN A. LAMBIE. CoUrhY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N. 0. CASH
�1kC3 2 2 7- FEB20 4 X050