HomeMy Public PortalAbout9832 LEMON AVE_Sewer__ Ok a 2�INSERTS
76A642D
TCPPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
t DEPARTMENT OF COUNTY ENGINEER,
UILDING AND SAFETY DIVISION BUILDING
ADDRESS
��OFIN A. LAMBIE, County Engineer h
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST
OR APPLICANT TP 9,14LINCROSS ST.
LEGAL +
—DESCRIPTION• LOT NO. OWNER
BLOCK hL TRACT MAIL /
Q ADDRESS
NO OF BLDGS. 67
�r
SIZE OF LOT NOW ON LO CITY TEL. NO.
FN
USE OF c DISTRICT N0. GROUP MAP PROCES D BY
BUILDINGS
BK PG r
CONTRACTOR
ADDRESS �,*— CO CTIO DATA
YCITTEL N0. C��O TION DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO COUNTY OWER
• NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO �/ 0
PUBLIC SEWER @ $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.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.- V
WORK TO HOUSE SEWER @ $1 00
SEWER OR DAIR OR ABANDON ISPOSAL SYSTEM HOUSE STATE @ $100 PERMITENCROACHMENT 030
PERMIT NO
INDUSTRIAL
_ - WASTE APPROVAL a
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE Qo REIMBURSEMENT FEE
IHAVE AT TRACTOR TO CIS DATE A CONTRACT ONNECT THE ABOVE DES RIBED EXH THE ISTING DWELLING EIN NAMED CON- -APPROVALS - DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN of04
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 STATELAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS.✓ - SEWAGE DISPOSAL SYSTEM
1 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 IAL PROP RTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE �i SE$E.PIT(S) ❑ CESSPOOLS
OF PERMITTE
®R VALIDATION ROBERT A. W O
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
05 4 6f1FR 7 1 0 5 .00
5 '
TEMPLE CITY
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cesos e•ee APPLICATION FOR PERMIT 7
COUNTY OF LOS ANGELES1
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUII.DING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLIC T TO ceoss sr.
LEGAL r
DESCRIPTION LOT N0. OWNER /-
BLOCK )IF `,vAL
TRACT�� � A DRESS Ke
SIZE OF LOT [/A� NO OF BLDGS.
N W N LOT CITY TEL NO
USEOF WMMQ
BUILDINGS - DISTRICT NO GROUP MAP PROCES BY
BK PG
CONTRACTOR _
ADDRESS CONNECTION DATA
CITY TEL.N0. / ION DEPTH l /
G/ �111111-COUNTY MANHOLE REFERENCE O
REGISTRATION N0. ' LOWER
NO. 1 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD _
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. N0. JOB NO.
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ $1 00
9,5 ZEI
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGDATE A CONTRAWITH THE HEREINAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS- SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
t 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
1 HEREBY 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 TH T 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE AL PROP RT BACKFILL SEPTIC TANKS ❑
SIGNATURE
G SE PIT(S) ❑ CESSPQQLS
OF PERM ITTET:
®P VALMA OROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
5047 APR 7 2 5 .0 0