HomeMy Public PortalAbout10836 ARROWOOD ST_Sewer__ —:
76A642 DIVISION OF BUILDING AND SAFETYAPPUCAT ®� �®� ����l ¢j
S&E-663 11-35 f,(
SEWER—StWAGE DISPOSAL cls
Department of County Engineer
County of Los Angeles Bu1LDING - ® `ft
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® -CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY / 7771
FOR APPLI
CANT• TO FILL IN 'CR ST.LEGAL
ESCRIPTION LOT N0. OWNERs�® � + '" l✓ !_ �
} MAI L
BLOCK TRACT �,�g - ® ADDRESS "s 8 316� ' X GQ�¢�� B4O
OF SIZE OF LOT 6' :/ X �'�7,poOy ONLOT / v `�.e.7
CITY T NO.
e' USE OF DISTRICT NO. GROUP MAP
BUILDINGS �, .�/ti
BK PG -
CONTRACTOR
+` ADDRESS CONNECTION DATA
STATION V/ DEPTH
CITY TEL. NO. -
MANHOLE REFERENCE-' k C UPPER
❑ STATE
REGISTRATION NO. ❑ COUNTY -
's NO. DESCRIPTION OF WORK FEE TYPE OF CONN ECTIO LENGTH FROM p� /
I HOUSE SEWER CONNECTING TO j-� Y- - CURB P.L;; M.L.TO P.L, o.C '
PUBLIC SEWER @ $3.50 Q v
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD '� P. C. N0.
' EXTN..CESSPOOL,DRYWELL,MAN HOLE @ $ 2.00 c CO. IMP. NO. j�� JOB NO.
HOUSE SEWER CONNECTING TO
< PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR •STATE ENCROACHMENT
WORK TO HOUSE SEWER' q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL '
0
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00"
- REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE- .INSPECTOR'SSIGNATU RE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
+ TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 S� CONNECT ADDITIONAL
OWNER OR ie� BUILDING OR WORK
OWNERS'AGE �T (� SEPTIC TANK,SEEP, PIT(S)
-ADDRESS 4Ae AND/OR-DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 'HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ._
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE yp SEEP. PIT(S) ❑ CESSPOOLS.
OF PERMITTEE -s✓ a/±�
,•-
JOHN A.•LAMBIE, COU Y ENGINEER VALIDATION ROBERT•A.WOOD. CHIEF PLBG. INSPECTOR
CK. M.0. CASH `
LL C3 7 5 2 . 'BAR . 5 4 4.50 �