HomeMy Public PortalAbout5002 ARDSLEY DR_Sewer__ S&E-6 311.55 APPUCA`i ON FOR PERMIT -
DIVISION OF BUILDING AND SAFETY S EW E ' SEWAGE DISPOSAL
Departrnent of County Engineer ,
County of Los Angeles BUILDING s X1- O. O
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ' J
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
NEARES
FO APPLICANT TO FILL IN ag-SS STT„
LEGAL _
DESCRIPTION LOT NO. OWNER
63
MAIL
BLOCK TRACT 13F2q! pDDRESS,L
0. OF BLDGS. CITY �, /r EL. N0. v
SIZE OF LOT _� NOW ON LOT �. !/ra' ..1
USE OF • }� 'DISTRICT NO. ROUPb - MAP
B .
UILDINGS q9
BK PG
UP
ADDRESS CONNECTION DATA
P �. .
STATION �Q�J'Q' DEPTH
- CITY L. N0� _ MANHOLE REFERENCE
/ •• ❑ STATE LOWER
REGISTRATION NO. � ❑ COUNTY -
NO. DESCRIPTION OF WORK FE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
- Y, CURB P.L. M.L. TO,P,L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR "
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO. -
EXTN.,CESSPOOL,DRYWELL,MAN HOLE.@ $2.00 CO. IMP. NO. - JOB No.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $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
SEWER OR DISPOSAL SYSTEM' Q $1.00 WASTE APPROVAL '
CHARGES
CONNECTION CHARGE'F_EE
OWNER'S PERMIT. $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE' .
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN •A
NAMED CON- APPROVALS DATE INSPECTOR'SSIG TURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SPWE/R✓. ' NEW HOUSE SEWER
SIGNED THIS'/- '? DAY OF b 19.T-7— ° CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT' SEPTIC TANK,SEEP,.PIT(S)
ADDRESS r r _ AND/OR DRAINFIELD
i
I HEREBY ACKNOWLEDGE H THAT I HAVE READ S APPLICATION CESSPOOL❑ DRYWELL F-1 "
AND STATE THAT THE ABOVE IS CORRECT AND AdVE TO-COMPLY -;
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. S SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE..LEGAL OW —OF THE'ABOVE
DESCRIBED RESIDENT[A .RO✓ / / BACKFILL SEPTIC TANKS '
SIGNATURE / SEEP.PIT(S) ❑ CESSPOOL
S❑
OF PERMITTEE-
JOHN
ERMITTEE JOHN A. LAMBIE. COUNTY ENGINEER VALIDAT ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH -
3 7 6 2 OGT'.'-" 4
4.50