HomeMy Public PortalAbout9750 LEMON AVE_Sewer__ D
SINE-688 I1-SS APPLICATION FOR PERMIT 1
8&E-8 '
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NOW{ ♦ j OWNER
MAIL
BLOCK - TRACT X,�3DDRESS
NO.OF BLDGS CITY �� TEL. N0. '
SIZE OF LOT - NOW ON LOT
USE OF
BUILDINGS 00 4
DISTRICT NO. GROUP BK I MAP
PG
CONTRACTOR
ADDRESS CONNECTION DATA
STATION DEPTH
CITY TEL. NO MANHOLE REFERENCEPPER
TAT V r � '
REGISTRATION ❑ COUNTY
NO DESCRIPTION OF WORK FEE,
HOUSE SEWER CONNECTING TOTYPE 0 CTION LENGTH FROM
PUBLIC SEWER @ $3.50 lkqZ CURB M L TO P.L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @- $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD 1 P. C. N0.
EXTN ,CESSPOOL,DRYW ELL,MANHOLE Q $ 2 00 CO IMP NO / 10B NO.
HOUSE ER
PRIVATE DVIS OSAL SYSTEMG TO Q $100 TRUNK PERMIT NO. - ROAD PERMIT NO.?//
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $100 PERMIT NO. - -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM a $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE.FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED co N. APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS i JA 19 CONNECT ADDITIONAL
OWNER OR ^ BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD- '
I HEREBY ACKNOWLEDGE THAT 1 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 '
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T T 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESID L PROP TY t BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PITS) ❑ CESSPOOLS
OF PERMITTE54 -
JOHN A LAMBIE• COUNTY•ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK d 0ASH
� ,i. 8 4 7rn Aw30 . 4 4.50
76A 642D-CEBOB-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS O
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST e
LEGAL yt
DESCRIPTION LOT NO Q /0�� � C/ OWNER / � �
MAIL
BLOCK TRACT ADDRESS ' 0
NO OF BLDGS
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS IfADISTRICT NO GROUP BK MAP PROCESSED BY
PS
GONTRACTOR r"
ADDRESS CONNECTION DATA
CITYTEL NO STATION DEPTH
STATE 1-IC MANHOLE REFERENCE UPPER
LICENSE NO CLASS LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L ML TOP L
PUBLIC SEWER @ $7 00
SEPTIC TANK SEEPAGE PIT OR PC NO
PITS AND/OR DRAINFIELD @ $1000
CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d
PRIVATE DISPOSAL SYSTEM @ S300 O
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE V
WORK TO HOUSE SEWER @ $300
OVERFLOW SEEPAGE PIT DRAINFIELD p(
EXTN CESSPOOL DRYWELL $500 O
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING 0
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT ' V
MANHOLE Q $7 00 PERMIT NO d
INDUSTRIAL L, h
WASTE APPROVAL "J 7
CHARGES
OWNERS PERMIT s 3 DO
AUTHORIZATION I TOTAL FEE 4 1
C? ig CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT IAM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE r-
OF PERM BACKFILL SEPTIC TANKS ❑
SEEP PIT(S) SSPOOLS ❑
VALIDATION CK M.O. CASH
177 D 6.00 �`•:,