HomeMy Public PortalAbout9838 LEMON AVE_Sewer__ DEPAIVrAIENT OF COUNTY ENGINEER 1
�E�Ett®SE��GE ®ASIa®SAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING �rJa�
ADDRESS _zp p� ��4jr) �V
' FOR APP CANT TO FILL IN LOCALITY
BUILDING p I NEAREST
ADDRESS q J L Ae M _ CROSS ST.
LOCALITY -t� �.. DISTRICT SERIAL NO. PERMIT NO.NEAc
CROSS ST. CZ„o /CL e—`�was /.} � A J
�50���' �
//�� /�� E�CsEI�VEED,BY Ready for Inspection DATEISSUED
OWNER �P7i !b_6L � �5 A f'e �� (4✓�
MAIL
ADDRESS G D 9 MGA/ USEZON9 OCCUPANCY
BK PG
CITY t TEL.NO. /mac ��{6 � N�I )`�S� 4-
CONTRACTO f
CO.IMP.N0.
ADDRESS f,
JOB NO.
CIT N
TRUNK PERMIT NO.STATE
REGISTRATION N/ 8 COUNTY
ROAD PERMIT NO. �Oarl ell
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 54,w7,�* WASTE INDUSTRIAL
SIZE OF LOT N0.OF BLDGS.
7f- X 3d NOW ON LOT Z CHARGES � p
USE OF ' _
gy
BUILDINGS {2e5/�Gf. edl5 � �F}%G' F}Ca e--- CONNECTION`HARGE FEE
NO. DESCRIPTION OF WORK FEE
_ `�a"
HOU SEWER CONNECTING TO REIMBURSEMENT FEE`" �A
PUBLICSEWER @ $ 3.50 ,_�j C^) RECEIPT NO. -DATE� I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 1�0
ALTER OR REPAIR EXISTING 00,01NO. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION ���� DEPTH ,�, S
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 er
,r/� pyFHPLE REFERENCE LOWER
1 TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT gp� CURB-N) M.L.TO P.L. 7
AUTHORIZATION TOTAL FEE I ISO '
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS......Z__._._._.DAY OF.___.41v/
r ..._.___.19 NEW HOUSE'SEWER 01
OWNER ORS., CONNECT ADDITIONAL
OWNERS AGENT- - _GL .....rL>� BUILDING OR WORK
R /ti,d/� SEPTIC TANK,SEEP.PITS)
ADDRESS_....__._._. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH"ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE OW
ER OF THE ABOVE DES ED RE E T PERTY BACKFILL SEPTIC TANKS❑
SEEP.PIT(S)o CESSPOOLS
SIGNATURE
OF PERMITTEE"_ " ..__ .___._. ._ _._._____._ "
MMMMgA642D 663 1/53UN
A642D
CEeoa a.sa /� P 'C TION
I O N R E E R M I TSEWER-SEWAGE DISPOSAL..
ceCOUNTY OF LOOS ANGELES e .
'DEPARTMENT OF COUNTYLRB-maM
EER
WELDING AND SAFETY N BUILDING _
ADDRESS
JOHN A. LAMBIE, CountF
CASSAIT D. GRIFFIN, Sup t g LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CRosS ST.
LEGAL
DESCRIPTION LOT N0.t /� s �446* OWNER
BLOCK TRACT MAIL a�
ADDRESS
NO OF BLDGS, -„�
SIZE OF LOT NOW ON LOT .✓�. CITY TEL NO
USEOF OUP
BUILDINGS DISTRICT NO. GRJ MAP PROCESSED BY
K PG
CON'TR,Xftj
ADDRESS CONNECTION DATA
STATION DEPTH
TATE MANHOLE REFERENCE _ UPPER -
REGISTRATION NO 62-Y6y L1 COUNTY - LOWER
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 AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
PRIVATE DISPOSAL SYSTEM @ $1 00
HOUSE SEWER CONNECTING TO �01 P N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1 00
ALTER,REPAIR OR ABANDON HOUSE 'STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT s 2 00 S^ rims rueor_r rrr
AUTHORIZATION TOTAL FEE URGE .-•T_EE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
fe
TRACTOR TO",CONNECT THE ABOVE DESCRIBED EXISTING 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
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [:I 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 THAT I AM THE- LEGAL OWNER OF THE ABOVE
DESCRIBED RESI TIAL OPERTx. BACKFILL SEPTIC TANKS ❑
SEEP.PIT(S) ❑ CESSPOOLS ❑
SIGNATURE
OF PERMITTE
®F - VALIDATION ROBERT WOOD
•
CK. M.o, CASR SUPERVISING MECHANICAL ENGINEER
t 6 1 2 JuI1 2 1 0 u 3 .0 0 ,