HomeMy Public PortalAbout5446 ARDEN DR_Sewer__ 79A9420
CE908 9.59 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL .
DEPARTMENT OF CLSupof
NGINEER
BUILDING AND SISION BUILDING
•
JOHN A. LAMBIE, ineer ADDRESS
CASSATT D. GRIFFIuilding LOCALITY
NEARESTDX
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL n 6e_5_ �L�fi—(jV '�i� 1la� Y off OWNER
_DESCRIPTION LOYNO.a'`' FC6
'ice ��(t.�
J `
BLOCK TRACT !� MAIL
M �� r tt�l.J d ADDRESSiG> 4 eo
NO.OF BLDGS.
SIZE OF LOT `L OC-► NOW ON LOT L Y3 '� TEL. N0. i
USE OF
BUILDINGS DISTRICT fqO. GRO PI MAP PG ( PROCESSEDBY
K
CONTRACTOR � +
ADDRESS 73 r CONNECTIO DATA
CITY [g�' TEL.NO. Jt // STATION. DEPTH
3S ATE MANHOLE R. E NCE UPPER
REGISTRATION NO. / C�' COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNEC-10N LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y, B P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELDG';''
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO v P.6.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP..NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR �- TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
`. WASTE APPROVAL
CHARGES
OWNERS PERMIT $ ]EN
00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN CON- +TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINLLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. , LSIGNED T DXY OF I2 , NEW HOUSE SEWER
OWNER ORI / � / CONNECT ADDITIONALOWNERS AGENT 12.E-t%t- � � �[ �f..iBUILDING OR WORK � ]a, e��,�,_��ym.-.",-,_.-�ADDRESS + �,�5 b�-,^ 2.;-i; P:,��/ /.►"tF SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREEMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS TING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTED/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 11_AMPHE LEGAL OWNER OFBOVE
DESCRIBED REST NTI ROPERTY.-, BACKFILL SEPTIC TANKS ❑
SIGNATURE -✓ SEEP.PIT(S) ❑ CESSPOOLS El
OF PERMITTE
OF VALIDATION ROBERT A. WOOD
Cu. 11.0. H" SUPERVISING MECHANICAL ENGINEER
LA,O 7 5 9 91 FEAR 1 4 A 3.00