HomeMy Public PortalAbout9844 LEMON AVE_Sewer__ 76A 6420-CE808-10-71 APPLICATION FOR PERMITfl
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 14 /♦
ADDRESS .L
LOCALITY Lf~ P,ROCESSED
NEARESTW � ^eFOR APPLICANT TO FILL IN =ROSS ST (3'LEGAL
DESCRIPTION LOT NO OWNERMAILBLOCK TRACT ADDRESSNOOBLDGS SIZEOFLOT NOWON LOT CITU TEL NOIfUSE OF DISTRICT NO GROUP MAP
BUILDINGS
t•�, ` BK pG
CONTRACTOR W
ADDRESS ��•// "`���((C••//� CONNECTION DATA
CITY TEL NO STATION DEPTH
STATE LIC MANH EREFERENCE UPPER
LICENSE NO CLASS LOWER
NO DESCRIPTION OF WORK FEE TYP F CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L
PUBLIC SEWER @ $7 00
SEPTIC LANK SEEPAGE PIT OR P C NO
PITS AND/OR DRAINFIELD @ 51000 CO IMP NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO C-
PRIVATE DISPOSAL SYSTEM @ $3 00 O
CONNECT ADDITIONAL BLDG OR D AFFIDAVIT I WAIVER I EASEMENT RECORD INSTR NO
WORK TO HOUSE SEWER @ $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $5
00 HWV OR ST WIDENING O
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ S300 STATE ENCROACHMENT W
MANHOLE 0 $7 00 PERMIT NO 0-
INDUSTRIAL (J)
WASTE APPROVAL Z
CHARGES
OWNERS PERMIT S 3 00
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE C)
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE R e APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY F 197 '01
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THELEGAL WNER OF AND INTEND TO DISCONNECT PLUG AND ^
RESIDE IN THE ABOVE ESCRIBED DENTIAL PR PERTY ABANDON HOUSE SEWER
SIGNATURE ACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP PITS) 8 SPOOLS ❑
VA IO14 CK. M 0 CASH
�'� 0 7 ? 5 73 APR 2 4 1 0 D 6.0 0
&E-6°
8 83 11.89 APPLICATION FOR PERMIT
&E•8 1
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL 1
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO OWNER
MAIL r
BLOCK TRA ADDRESS
NO. OF BLDGS3,. CITY TEL. NO
SIZE OF LOT NOW ON LOT
USE OF BUILDINGS DISTRIC�)) I GROUP MAP
,
BK, _PG
CONTRACTOR III( Al 16
ADDRESSZ , 1 9j &L //CJJONNECTION DATA
STATION F4,;2, S DEPTH
CITY ^./ TEL. NO, Q MANHOLE REFERENCE J� PPER -
8--STATE
REGISTRATION NO Z ❑ COUNTY
NO DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO J' Y• M L TO P.L.
PUBLIC SEWER @ $3 50 7
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD CO IMP. NO IMP. NO `��10B NO
OO
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO �/1���
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO [/
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 Z U tj PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE U V L2
OWNER'S PERMIT $ 1 00 REIMBURSEMENT FEE / j/�Q�- AID ULQ (fjdPzs
AUTHORIZATION I TOTAL FEE b
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS OF 19 CONNECT ADDITIONAL _
OWNER OR BUILDING OR WORK
OWNERS AGENT
- 64 1 v N IF - SEPTIC TANK,SEEP, PITS)
ADDRESS AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT I HAV 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGEL COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR,THAT 1 THE L L OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P OPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE - - '
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT-A WOOD, CHIEF PLBG. INSPECTOR
CK. M 0 CASH