HomeMy Public PortalAbout5430 ARDEN DR_Sewer__ CE808559•. ��G��,0���9 � FOA PERMIT
COUNTY -
COUNTY"OF LOS'ANGELES StWER—SEWAG DOSPOSAL ,
" DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION TN
DING �..,
1 RESS ,'}.'(� •'/'.•
JOHN A. LAMBIE''County. Engineer
CASSATT D. GRIFFIN,'Sup t of Building ALITY ti
RESTFOR'�APPLICANT TO FILL. IN" S
ST.
FREG,STRAT,0N'NO.
AL
PTION- " LOT NO r OWNER i t
c8`�'{,z7 MAI L
TRACT . t.-�i ��1)�s A ,1, i ADDRESS. i�{
NO.OF BLDGS. , -:-y, ff LOT' N01N-0H COT CITY\ �� �) 1, '�`� TEL. NO.. DISTRICT NO. GROUP MAP. PROCESSED BYNGS gKPGCTOR "CONNECTS ,� �`�.' ��-�ct.- � �:S.r I'�� �I :�TEL:NO. STATION ' DEPTH
_ STATE MANHOLE.REFERENCERATION N0, � Q.� -7 �• ,COUNTY :J �ftf,,.,p^;�e / LOWER
NO.. :DESCRIPTION OF WORK - FEE -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00. :_ C5 ) PE OF CONNECTIO _L. LENGTH FROM77 '
e
SEPTIC'TANK;SEEPAGE PIT OR - Y. CURB j Q
__M:L:'TP.L, _.. �'
PITS AND/OR DRAINFIELD-" .@-$3.00 - '-
OVERFLOW SEEPAGE PIT 'DRAINFIELD,
:'EXTN...CESSPOOL.DRYWELL @ $2.00 '
HOUSE SEWER CONNECTING TOnim/ P:C.:NO:
PRIVATE DISPOSAL SYSTEM .@ $1.00 1 CO.IMP.:NO, JOB N0;
CONNECT ADDITIONAL BLDG,OR`
WORK TOHOUSE SEWER @ $1.00
•TRUNK,PERMIT NO. ROAD PERMIT NO.
•' . - -
STATE
ALTER;REPAIR OR ABANDON HOUSE '" A -
' � ENCROACHMENT- • - - ,' ''
SEWER
OR-DISPOSAL SYSTEM @ $1.00 � � PERMIT-NO.
` - INDUSTRIAL - -
WASTE APPROVAL '
-CHARGES -
OWNER'S,- PERMIT $ '2 00 CONNECTION CHARGE EEE
AUTHORIZATION TOTAL FEE / T 6 REIMBURSEMENT FEE
1 HAVE.AT'THIS'DATE:A CONTRACT WITH THE HEREIN NAMEDCO
TO CONNECT THE-ABOVE DESCRIBED. EXISTING. DWELLING APPROVALS, DATEINSPECTOR'S SIGNATURE:
TO"THE.PUBLIC SEWER. / // __ -
SIGNED THIS DAY OF e r l9lfzl'� NEW.HOUSE SEWERA,-
r
OWNER OR
NT Jr�,,,• _ CONNECT ADDITIONAL
OWNERS AGE "Y -� 'BUILDING ORWORKw
--JKt SEPTIC TANK,SEEP,PIT(S)
ADDRESS �`' Zr� =y'a "� t.L`"t'O•'kt-C j•"- I •r .AND/OR DRAINFIELD -
HEREBY;ACKNOWLEDGE, THAT' 1 HAVE READ.THIS,APPLICATION
AND STATE THAT THE.ABOVE IS .CORRECT AND AGREE'TO COMPLY CESSPOOL.EI,•DRYWELL ❑ '- '
WITH ALL--COUNTY ORDINANCES AND STATE LAWS REGULATING. ,ALTER,REPAIR,SEWER OR
.PLUMBING,AND SEWERS.
i. .SEWAGE DISPOSAL SYSTEM •
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED. AND/OR -
LICENSED AS REQUIRED BY..LOS.ANGELES COUNTY-AND.STATE OF - DISCONNECTPLUG..AND..
'ABANDON.HOUSE SEWER
CALIFORNIA OR THAT 1 A THE. •LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P OPBRTY - BACKFILL SEPTIC TANKS ❑
SEEP.PIT-(S) ❑ CESSPOOLS ❑ --
SIGNATURE C ' � - ...
OF PERMITTEE -
,�F VALIDATIO . ROBERT A.-WOOD
cK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
SAE? 6 0 0 HIS 1 ,20. A