HomeMy Public PortalAbout10835 ARROWOOD ST_Sewer__ S&E-6 D A W 0 U Com` T O II V FOR P E R pIHF/[I� {I
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DIVISION OF BUILDING ARID SAFETY SEWER SEWAGE DISPOSAL
Department of County Engineer "t '•� -
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CRNS ST.
LEGAL
P_ DESCRIPTION LOT NO. OWNER
MAIL
(F Q V - ADDRESS
BLOCK TRACT _ / f -
•� y NO.OF BLDGS.
SIZE OF LOT J �L•NOW ON T CITY TEL. N0. v
NILIN
USE OF *DISTRICT NO. GROUP MAP
BUILDINGS -
_ BK PG
t CONTRACTOR - ' � 'ea o III
CONNECTION DATA ���JJJ
ADDRESS
` STATION 8 DEPTH
CITY - T El
r MANHOLE REFERENCE Q/ EIA<ST UPPER
❑ STATE
REGISTRATION NO. ❑ COUNTY
No. . DESCRIPTION OF WORK FEE
TYPE OF CONNECTIOL
HOUSE SEWER CONNECTING TO NG FROM
PUBLIC SEWER @ $"3.50 O �` Y. CURB /ir•L_9 M.L. TO P.L. 7
n
SEPTIC TANK,SEEPAGE PIT OR
"PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C.'NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @. $2.00 CO. IMP, NO. 10B NO. -
HOUSE SEWER CONNECTING TO Av ..
PRIVATE DISPOSAL SYSTEM @ $1.00 I 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 @ $1.00 s WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE'AT THIS DATE A CONTRACT WITH THEHEREIN .NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER � �•6
SIGNED THIS D All CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGE Tj SEPTIC TANK,SEEP,PIT(S)
ADDRESS _ AND/OR DRAINFIELD -
I WLEDGE H HEREBY ACKNOTHAT I ONE READ THIS APPLICATION ?, CESSPOOL.❑ DRYWELL❑ -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE-TO COMPLY ti
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. S SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERL REGI RED AND/OR DISCONNECT PLUG AND.'
LICENSED AS REQUIRED BY LOS ANG ES UNT ND ST E OF
CALIFORNIA OR THAT I AM HE AL WNE OF TH ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PR BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CES POOLS❑
OF PERMITTEE y ®
f -
JOHN A. LAMBIE, COUNTY ENGI ER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M. 0.
4282 MM � 4.50 �'