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HomeMy Public PortalAbout9704 LEMON AVE_Sewer__ DEPARTAIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ^ ADDRESS �� � '� Ip pyo n 4Ve FOR APPLICANTE FILL IN LOCALITY C- 41a BUILDING n NEAREST " ADDRESS ��© � �. L�w �=. CROSS ST. I C. �1 � LOCALITY � '� DISTRICT N0. SERIAL N0. PERMIT N0. c NEAREST ��.r� c T .� A �S O� J CROSS ST s RECEIVED BY Ready for IriaDection DATE ISSUED OWNER 1ao-m LA - Q.-- . MAIL ,t USE ZOrIVE OCCUPANCY MAP ADDRESS BK PG CITY TELAO. !! 1 CONTRACTOR. 6. Nottingham otti^ham o. o Cf Temple City CO.IMP.NO. 7YUlli1C ADDRESS 5933 N- CI OVERLY AVE. JOB.NO. .-- CITY TEMPLEOI6>sf,NQALIFe — TRUNK PERMIT NO. l7 6 STATE REGISTRATION NO. �/ COUNTY ROAD PERMIT NO. LEGAL =�� j �7tZ STATE ENCROACHMENT DESCRIPTION LOT NO. S a PERMIT N0. BLOCK TRACT INDUSTRIAL L•,4 L. WASTE APPROVAL SIZE OF LOT NOW ON LOTS `� CHARGES USE OF BUILDINGS CONNECTION CHA.RGE FEE NO. DESCRIPTION OF WOR FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER $ 3.50 ® RECEIPT NO. � -"DATE_,__,_ I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR'REPAIR EXISTING I NO- DATE BY SEWER OR DISPOSAL SYSTEM 1.00 { �/ L DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR I PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH I CESSPOOL—DRYW ELL SPECIAL CONDITIONS ONLY 2.001 1 -F-:-, MANHOLE,REFERENCE I ` �I � ({'UPPER) X-,9_WEBf TYPE OF CONNECTION LENGTH FROM ^] / - CURB� ItPtr M.L.TO P.L. �[cS OWNERS PERMIT $ I ,p 1 00 AUTHORIZATION TOTAL FEE 14 4 1 HAVE THIS CONTRAED WITH THENAED -CONTRACTOR TDO CONNECT THE ABOVE D SCRIBEDIEXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER // SIGNED THIS.......`....--....DAY OF.__"L4 S,.I, ......._......19� " NEW HOUSE SEWER SaAYd G 5_7_ '4- C 1 CONNECT ADDITIONAL OWNER OR )�1` 7rr/ BUILDING OR WORK OWNERS AGENT. .. Yii�i SZL L� �O�+� SEPTIC TANK,SEEP.PIT(S) ADDRESS.... ......�_.... --����,6 ..�.. �.-.- AND/OR DRAINFIELD 1 HEREBY ACKNOWLE'17GE THAT I HAVE READ THIS APPLI. CESSPOOL E] DRYWELL E] CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STAL ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGDISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELESABANDON HOUSE SEWER AND STATE OF CALIFORNIA R TftTIlAMER OF THE A DE IBE BACKFILL SEPTIC TANKS ESIGNATURE ' SEEP.PIT(S)E] CESSPOOLSOF PERMITTEE- -------- 76A6421) 663 1/53ci /►( a