HomeMy Public PortalAbout9828 LEMON AVE_Sewer__ 76^6420
8Y-[1.6693.55 APPLICATION FOR PERMIT E, 1
DMSION OF BUILDING AND SAFETY S EWE R—S EWAG E D I S POSA L
Dep Count t of County Engineer
County Of L08 Angeles BUILDING
ADDRESS
WM.J. FOX, COUNTY ENGINEER
CA88ATT D.GRIFFIN, SUPT OF BUILDING LOCALITY �3 /y/w t ,�4 P
mJ-
FOR APP ANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER �1 IN
BLOCK TRACT MAIL
ADDRESS ;S,4/1 6ea A ,f'
0 O BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USOF
BUELDINGS O0 WAR 1-&/Al
��1v�� p/ ,�Q /� ry /� DISTRICT NO GROUP MAP
CONTRACTOR
{A A 77(j7 G '0 ® 6-��d � b A � � BK PG
ADDRESS 32X / CAAMA 44 N d rACONNECTION DATA
CITY AAC TEL NO.,4#r -1474? >STATION ! , D PTH Ir QZ
Yry STATE MANHOLE REFERENCE ` 'L.� UPP
REGISTRATION NO. €�L� LI COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO S�0 .b TYP C ECiI LENGTH FROM
gp,PUBLIC SEWER Q $ 3 50 •tom M L TO P
I
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG. ORP C N
P N
WORK TO HOUSE SEWER 1 00 6 f`J _ C I O JOB NO /JJJ
ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT NQC�a
SEWER OR DISPOSAL SYSTEM 1 00 /f��-�
DISCONNECT AND ABANDON SEWER
AND/OR STATE ENCROACHMENT DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
$ � 00
OWNER'S
PERMIT CONNECTION CHARGE FEE
n
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE TTOS CONNECTDATE ONTRTHEAABOVECTED WDESCRIBEDITH THE HER
EXESTINGIN A DWEL LING MED ON- APPROVALS (/ DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S E
SIGNED THIS DAY OF _19��----�Ff"` NEW HOUSE SEWER Z
d- 2-
OWNER OR /.1 _ CONNECT ADDITIONAL
OWNERS AGENT &46' BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 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 I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDE IAL PROPERTY. BACKFILL SEPTIC TANKS❑ �7 _Z
1 ' SEEP. PIT(S) [ICESSPOOLS 3-
SIGNATURE '
OF PERMITTEE -
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
r.'iC,6 2.9 � MAR 2 2 4 65 0 u)