HomeMy Public PortalAbout9223 LEMON AVE_Sewer__ `1
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CE808 11-87 APPLICATION FORPERMIT
EB08 7
COUNTY OF LOS ANGELES SEWER"—SEWAGE.DISPOSAL: 1■i
DEPARTMENT' OF COUNTY ENGINEER 1�f
BUILDING AND SAFETY DIVISION BUILDING
UILDI SGL /TG�� r
IOHN A. LAMSIE, County Engineer
CASSAIT D. GRIFFIN, Supt of Building � - --
LOCALITY C'Y?2 i t
FOR APPLICANT TO CROSS S'. -
LEGAL G e
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAILADDRESS
NO.OF BLDGS.,I�'
SIZE OF LO NOW ON LOT {+* CITY 4- 61;tTEL.NO.
-USE OF
BUILDINGS DISTRICT N0. I GROUP
MAP
CONTRACTOR OI BK PG
ADDRESS �� CONNECTION DATA
C TEL pNO. . d,�L 4 STATION DEPTH
REGISTRATION N0. /Q OUO�� COUNTY STATE MANHOLE REFERENCE
LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER-CONNECTING TO
PUBLIC SEWER @ TYPE 0 E TION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M L.TOP L
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN ,CESSPOOL DRYWELL,MANHOLE @ $2 00 -
HOUSE SEWER CONNECTING TOP.C. N0.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO.IMP.N0. JOB NO.
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES �
OWNERS PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION ` TOTAL FEE REIMBURSEMENT FEE
1HAVE AT THIS DATE-A CONTRACT-WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWEE
SIGNED THIS r't AY OF G ` 199 NEW HOUSE SEWER Y f `lA
OWNER OR- - CONNECT ADDITIONAL - -• - - - '
OWNERS AGENT'- a BUILDING OR WORK
`�" )2 SEPTIC TANK,SEEP,PIT(S)
ADDRESS - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS _CORRECT AND AGREE TO COMPLY CESSPOOL ElDRYWELL I-] -- --- - -
WITH ALL' COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM -
1 HEREBY CERTIFY THAT 1-AM PROPERLY REGISTERED-AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE_ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDEN L PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE � SEEP
PIT(S) El CESSPOOLS 11 '
OF PERMITTEE
®� VALIDATION ROBERT A. WOOD
crt m 0. CASH _ SUPERVISING MECHANICAL ENGINEER _
LAC01 6 4 8 JAN 8 1 O n 5,f3 0 M
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