HomeMy Public PortalAbout9708 LEMON AVE_Sewer__ -61
76A6423-61
APPLICATION FOR PERMIT
76A 842
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building LOCALITY
NEAREST
F PLIC cRoss ST
1 ,
LEGAL
DESCRIPTION &LO N OWNE
MAI
BLOCK TRACT ADD Si
NO.OF BLOGS.
SIZE OF LOT NDW`jON LOT CITY TEL. NO
USE OF
BUILDING DISTRICT N0. GROUP MAP PROCESS Y
CONTRALTO l BK PG
AooREss/ CO ',TION DATA
CITY L.N STATION�T_ �!"-D DEPTH
/I- STATE MANHOLE REFERENCE 3
REGISTRATION N0. COUNTY
No DESCRIPT ON OF W FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $8.00 TYPEOF ION LENGTH FROM -�
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD )..
EXTN. CESSPOOL.DRYWELL @ S2.00 d
HOUSE SEWER CONNECTING TOC.NO.
PRIVATE DISPOSAL SYSTEM @ E1.00 CO.IMP. H0. JOB NO. V
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER 51.00 TRUNK PERMIT N0. ROAD PERMIT N0.
SEWERREPAIR
R DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
to
CHARGES Z
OWNERS PERMIT $ 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
HAVE AT THIS DAA CONTRACT WITH THE HEREIN NAMED CN-
RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
THE PUBLIC SEWER.
GNED THI DAY OF 19_ NEW HOUSE SEWER
CONNECT ADDITIONAL
ERS AGENT BUILDING OR WORK
ES SEPTIC TANK,SEEP.PIT(S)
REBAY KNOWLEDGE THAT 1 AVE READ THIS APPLICATION AND/OR DRAINFIELD
ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWEROR
G AND SEWERS. SEWAGE DISPOSAL SYSTE
BY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
IA OR THA I AM THE LEGAL OW OF THE ABOVE
RESIDE L PROPE TY BACKFILL SEPTIC TANKS ❑
SEEP.PITS ❑ CESSPOOLS
TTE
vj{ MAnO*---- ROBERT A. WOOD
CIL M.o. ` CA3R SUPERVISING MECHANICAL ENGINEER
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