HomeMy Public PortalAbout10702 ARROWOOD ST_Sewer_5/7/1958_additional manhole 6420
5&AE-663 11-55 //"11PPUCATMIIFI FOR. PERD.1 T - II
DIVISION OF BUILDING AND SAFETY SEWER-S EWWAG[_. ®0§P0SA L
Deportment of County Engineer F• ' T .,'
County of.Los Angeles BUILDING �q
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS/'a
® CASSATT-D. GRIFFIN SUPT OFBUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST:
LEGAL ,f^
'• DESCRIPTION -LOT NO. OWNERMAIL
-
BLOCK " TRACT / z 6 ADDRESS
NO.OF BLDGS. CITY TEL. NO.
-'_ SIZE OF LOT - NOW ON LOT
USE OF vDISTRICT GROUP MAP
BUILDINGS BK PG
CONTRACTOR
ADDRESS -9,0, �p of(&W p C� - CONNECTION DATA
b eG. STATION. DEPTH
CITY /� N TEL. NO: 1S -
-+���! MANHOLE REFERENCE -. UPPER
❑ STATE _ LOWER
REGISTRATION NO. - ❑ COUNTY r
NO. DESCRIPTION OF WORK FEE - .-
HOUSE SEWER CONNECTING TO r" TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @-'$3.50
SEPTIC TANK,SEEPAGE PIT OR
.-PITS AND/OR DRAINFIELD - @ $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 @ $1.00 TRUNK PERMIT NO.' ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER_* @ $1.00 (j PERMIT NO. -
ALTER,REPAIR OR ABANDON HOUSE - INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 - WASTE APPROVAL' - -
CHARGES -
CONNECTION CHARGE-FEE; -
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE" ,
AUTHORIZATION TOTAL•FEE
1
HAVE 'AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- - APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR - . BUILDING OR WORK •" j } „yam,f�
OWNERS AGENT - SEPTIC TANK,SEEP,PIT(S)
ADDRESS - AND/OR DRAINFIELD -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑-
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM,
1 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
r DESCRIBED REST DEN AL ROPERTY.• BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTE46
x
JOHN A. LAMBIE, C NTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH -