HomeMy Public PortalAbout5424 ARDEN DR_Sewer__ .8&E-983 3-88 APPLICATION FOR PERMIT . -
P DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING `
WM.J. FOX. COUNTY ENGINEER ADDRESS
'®
CASSATT D.-GRIFFIN,SUP'T OF BUILDING - 'LOCALITY. !
FOR APPLICANT TO FILL INNEAREST .
. CROSS ST. 0 /7
LEGAL
DESCRIPTION LOT NO. &t OWNER
BLOCK TRACT MAIL .D,
ADDRESS
NO. OF BLDGS.
SIZE OF LOT - NOW ON LOT CITY TEL..NO.
USE.OF
BUILDINGS .DISTRICT NO.. GROUP. - MAP
BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY �' TEL. N0. r�4g:a��. D STATION 'DEPTH
701� El
MANHOLE REFERENCc' +�%� Q-7f LOWERR
REGISTRATION N0. COUNTY -- •/ C�rJ
No. DESCRIPTION OF WORK .FEE "
HOUSE SEWER CONNECTING TOTYPE OF CONNECTIOW^ LENGTH FROM
PUBLIC SEWER - @ $ 3.50 Y• _ CURB L. M.L. TO P.L.
HOUSE SEWER CONN.ECTING,TO .
--PRIVATE DISPOSAL SYSTEM - 1.00
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP. N0. JOB NO.
ALTER OR REPAIR EXISTING -
'SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. - - ROAD PERMIT NO. _
DISCONNECT-AND ABANDON SEWER STATE ENCROACHMENT -
AND/OR DISPOSAL SYSTEM 1.00 ,PERMIT NO. _
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD .00 INDUSTRIAL '
CESSPOOL=DRYWELL WASTE APPROVAL. _
SPECIAL CONDITIONS ONLY 2.00 - CHARGES
PERMIT
CON NECTION.CHARGE FEE
'OV6INER�S S 1 00.
AUTHORIZATION I TOTAL FEE 0 'REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- - >- ,1Y
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ,t APPROVALS DrAT E// JNSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER-
NEW HOUSE SEWER J
SIGNED THISZ. OF ]9 1
OWNER ORy . //� 2� CONNECT ADDITIONAL `
OWNERS- AGENT C'/ yt t - BUILDING OR WORK
f �+�L '/,- ,Q' / •' 'SEPTIC TANK,SEEP,-PIT(S)
J -
ADDRESS �17 u��` ,�7 AND/OR DRAINFIELD - -
i
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH ISV APPLICATION .CESSPOOL-❑ DRYWELL(:3AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ - -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM '
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES•COUNTY AND STATE OF DISCONNECT PLUG AND. -
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY., !q -
�. d�OTI�IHY,1 .4 _gam: �S . BACKFILL SEPTIC TANKS❑
1 V a' 3 TY� .SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE - - ✓ ''
OF PERMITTEE �� .P,�.,�✓;����e��
WILLIAM J:•FOX. COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
,r.0 7 7 2 -8 . IMAY. 1 4450 '�