HomeMy Public PortalAbout9710 LEMON AVE_Sewer__ _6,
76A6423-61
APPLICATION F® PERMIT
76A 642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEARESTILDING
JOHN A, LAMBIE, County Engineer DRESS
WILLIAM A. JENSEN, Supt of Building_ CALITY
FOR APPLICANT T IN OSS ST.
LEGALOWNER
DESCRIPTION LOT N l /
BLOCK TRAC q MAIL
j �,e L ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP OCESSED BY
CONTRACTOR BIK,� P6
ADDRESS % C NNEC ON DATA
CITY �� TEL.NO. STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. ® COUNTY
NO. 1 DESCRIPTIO OF _R FEE
a
HOUSE EWE
CONNECTING TOPUBLIC @ .00 <
TYPE OF CO E LENGTHFROM
SEPTIC TANK,SEEPAGE PIT OR Y. P.L. M.L.TO P,L.
PITS AND/OR DRAIN FIELD @ JI.00
OVERFLOW SEEPAGE PIT,DRAINFIELD ` - -
EXTN..CESSPOOL.DRYWELL @ 2.00 t, d
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ 1.00 y CO.IMP. NO. JOB NO. V
CONNECT ADDITIONAL BLDG.OR 5
WORK TO HOUSE SEWER 1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT Q
SEWER OR DISPOSAL SYSTEM @ 1.00 PERMIT NO. V
w
INDUSTRIAL /L
WASTE APPROVAL N
to CHARGES z
.ONERI3 PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZAnOr TOTAL FEE P70REIMBURSEMENT FEE
I HAVE 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 SEWER. �.
SIGNED THIS �DAAYYyOF 19_ NEW HOUSE SEWER
OWNER OR
OWNE S AGENT_�� ;� / CONNECT ADDITIONAL -
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM T E LEGAL OWNER OF THE ABOVE SEPTIC TANKS ❑
DESCRIBED RESIDENTIAL PR TY. BACKFISEEP.PLL LL TANKS
OLS
SIGNATURE
OF PERMITTE
VAIMAnOROBERT A. WOOD
CK. n.o. CASH SUPERVISING MECHANICAL ENGINEER
CEBOS
76A642 -61 AFl Il � CATI® FOR PERMIT
76A 642D (� �f
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
FOR FAPPLICANT TOS FELL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. �' CG OWNER
.1.,
BLOCK TRA /�. MAIL
C G� ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS SIL/ ✓ DISTRICT NO. GROUP BK MAP PG y CESSED BY
CONTRACTOR /F�j`
ADDRESS ® � CONNEC3°ION DATAff J'
CITY TEL.NO. STATION DEPTH
REGISTRATION N0. ® STATE 'I, MANHOLE REFERENCE UPPER
COUNTY
No. DESCRIPTIO OF _WORK FEE
HOUSE SEWER CONNECTING TO WAl
PUBLIC SEWER @ $3 00 '
MF E 7 ON LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. / P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $3100 _
OVERFLOW SEEPAGE PIT.DRAINFIELD :��, Z '.
EXTN..CESSPOOL.DRYWELL @ $2100
HOUSE SEWER CONNECTING TO P.C.NO. 0
PRIVATE DISPOSAL SYSTEM @ $1100 CO.IMP. NO. JOB NO. y v
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $ 00 TRUNK PERMIT N0. ROAD PERMIT N0. C
ALTER,REPAIR OR ABA 0 OUSE STATE ENCROACHMENT
SEWER OR DISPOSALS E @ $ .00 " PERMIT NO. V
t
_ - INDUSTRIALLLJ
WASTE APPROVAL
h
CHARGES
OWNER'S PERMIT CONNECTION CHARGE FEE
�A ORMATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACY WITH THE-.` T ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWED
ELLNAMED ING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— ' NEW HOUSE SEWER
; OWNERS AGENT CONNECT ADDITIONAL
�—�+� BUILDING OR WORK
' ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL 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 REOUIR D BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THA 1 THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDEN AL OPERTY. SEEP.PITS ❑ CESSPOOLS
' SIGNATURE
OF PERMITTE
VALIDATION---) ROB RT A. WOOD
CK. B.0. CASB SUPERVISING MECHANICAL ENGINEER