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HomeMy Public PortalAbout9830 LEMON AVE_Sewer__ ' 2 60 INYRTS CE6096.60 APPLICATION FOR PERMIT ' . 78A6420 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, Supt of Building LOCALITY NEAREST FOR APPLI ANT T nV CROSS ST. LEGAL MA DESCRIPTION LOT N0. OWNER BLOCK TRACTS MAIL ADDRESS 1 •1/L (� - ,NO OF BLDGS. SIZE OF LOT NOW ON LOT (CITY TEL NO - USE OF DSTRICT NO. BUILDINGS IGROUP MAP PROCESSED Y--/� I BK PG I CONTRACT ADDRESS CONNECTION DATA CIiY� TEL NO. TIO DEPTH a sy STAT MANHOLE REFERENCE REGISTRATION NO / G �� COU TY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER Co) $3 00 TYPE OF CONNECTION 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 @ $2 00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. NO JOB NO. W CONNECT ADDITIONAL BLDG ORI' TRUNK PERMIT NO. ROAD PERMIT NO. U WORK TO HOUSE SEWER @ $ 00 SEWER ALTER OR DISPOSAL SYSTEM IR OR ABANDON HOUSE @ $1 00 STATE ENCROACHMENT to PERMIT NO O INDUSTRIAL U WASTE APPROVAL W CHARGES Y1 OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE ,• AUTHORIZATION TOTAL FEE © REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPEC'TOR'S SIGNATURE TO THE PUBLIC SEWER. _ �4 SIGNED THIS OF - 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT_? - r BUILDING OR WORK - - ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I 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 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 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDE AL PROP TY. BACKFILL SEPTIC TANKS ❑ SIGNATURE G SEEP.PITS ❑ C SS OLS OF PERMITTE ®P VALWATIOI�P� ROBERT A. WOOD CK. y o (CASH SUPERVISING MECHANICAL ENGINEER -_ ,�0 5 0 4 4 l,rl: 71 5,.O 0 ' TEMPLE -CITY CEe0578. APPLICATION FOR PERMIT 808 8.58 7 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN IL LAMBIE, Count En weer ADDRESS CASSATI D. GRIFFIN, Sup t of BuildingLOCALITY NEAREST FOR APPLICA T., CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER BLOCK TRACT MAIL ' _ - Q ADDRESS NO.OF BLDGS., SIZE OF LOT(O�/� ,3 NOW ON LOT CITY 'TEL NO USE OF DISTRICT NO. GROUP MAP PROCESS %Y BUILDINGS BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY / jTEL.N0. ��f A NDEPTH 5�,2 oe to / / / — T "L.� STATE ANHOLE REFERENCE REGISTRATION NO COUNTY OWER No I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER . @ $3 00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. , PITS AN DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 _ HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP.NO JOB NO. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT N0. ROAD PERMIT N0. ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM $1 00 PERMIT NO. INDUSTRIAL WASTE APPROVAL _ CHARGES OWNERS PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE CON- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGDATE A CONTRACT WITH THE HEREINAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS----:.--D Y OF 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS_ SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD - I HEREBY ACKNOWLEDGE THAT 1 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 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF' THE ABOVE DESCRIBED RESIDE AL PROP RTY BACKFILL SEPTIC TANKS ❑ - SIGNATURE SEV.PIT(S) CESSP OLS OF PERMITTE ®r VAIMATIO*— , ROBERT A. WOOD CILM.O, l/Jcksv SUPERVISING MECHANICAL ENGINEER 50 4 5a t1iR 71 1 D 25.00 ' m