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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 ,