HomeMy Public PortalAbout5442 ARDEN DR_Sewer__ APPLICATION FOR PERMIT
claeoe a-so COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING .—
ineeADDRESS `�
C SATOHNE DI. GRIFFIN, Sup! of Building LOCALITY a
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. c-
LEGAL So `j ej .. d-
DESCRIPTION &T
N . * y�. --y 1"` OWNER 0
v
MAIL
BLOCK TRACT
� ,�, C: ADDRESS fNO.OF
-
SIZE OF LOT 'C I f D C.' NOW ON LOTS CITY t. TEL. NO. t'
USE OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS Aa >.� BK PG
CONTRACTOR �J
ADDRESS ;p 1 1 r'• �s G CO NECTION DATA
CITY 11 r{L h TEL.NO. 1 h STATION DEPTH
17 STATE MANHOLE REFERS Ir UPPER
REGISTRATION NO. f Q COUNTY LOWER
NO. DESCRIPTION OF WOR FEE
HOUSE SEWER CONNECTING TO _ r _15"PUBLIC SEWER @ $3.00 - TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,_ PTS AND/OR DRAINFGELDT OR @ $3.00 Y. URB P.L. ` M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
_ PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
Tt WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR DOSAL SYSTEM ABANDON HOUSE @ $1 00 ' STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVTNEWS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 11 DC) REIMBURSEMENT FEE
CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDATE A CONTRACT WITH THE IINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLK SEWER. 1
SIGNED TH _V DAY OF CIA 190_ NEW HOUSE SEWER
OWNER OR Y � _ J''I CONNECT ADDITIONAL
OWNEAk /,.I t
�I
BUILDING OR WORK
'.I�' l�.�s61 �G e•
`l, C•w*a rb 1.L'1-t7-dr/ l�.�V (j SEPTIC TANK,SEEP.PIT(S)
ADDRESS "
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 A 1T'HE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDEN`IA 1 OPERTY. I , BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ElCESSPOOLS ElOF PERMITTE 'e/
n
®F VALIDATION j ROBERT A. WOOD
CK. M.o. CASH SUPERVISING MECHANICAL ENGINEER
A 3.0 0 M
L,jG 7 5 9 8= MA