HomeMy Public PortalAbout9852 LEMON AVE_Sewer__ CEBOB?8.88 _ APP.LICATIOIV; FOR Pt IT -
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL' 1.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
'JOHN A. LAMBIE. County Engineer
CASSATT D. GRIFFIN, Sup't ot'Building LOCALITY
NEAREST
FOR;APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO• .�' OWNER
BLOCK TRACT H MAIL
•ADDRESS
N0,OF BLDGS.
[SIZE OF LOT NOW ON LOT CITY TEL N0.
USE OFMENEM
BUILDINGS' DISTRICT N0. GROUP BK MAP pG ROCESSE BY
CONTRACTOR •' - � +
ADDRESS j CONNECTION DATA
CITY TEL. NO. 40',q 4e d'j5'_ STATION O DEPTH
STATE
REGISTRATION NO. B COUNTY MANHOLE REFERENCE,V C
NO. DESCRIPTION OF WORK TrEE SJ E
HOUSE SEWER CONNECTING TO31
PUBLIC SEWER @ $3,00 Q 2i�`� LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR TYPE-OF CONNECTI0 PITS AND/OY. CURB P.L, 7 M L.TO P.L. �y
AND/OR DRAINFIELD @ $3.00 —
OVERFLOW SEEPAGE PIT, DRAINFIELD ,
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 -
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 rn.imp pin
CONNECT ADDITIONAL BLDG. OR iRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAUSYSTEM @ $1.00 PE MIT NO.
INDU
WASTE APPRO `
' S
OWNERS PERMIT $ 2 00 CONNEC N CHARGE FEE
AUTHORIZATION 1 TOTAL FEE 0 REIM SEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS 'U _ DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS SAY OFl g_ NEW HOUSE SEWER
OWNER OR � � ) BUILDING ORNECT WORKOWNERS AGENT '-
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD,
LEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
TE THAT'THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
G AND SEWERS. SEWAGE DISPOSAL SYSTEMEBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORDISCONNECT PLUG AND
D'-AS REQUIRED BY LOS ANGELES.COUNTY AND`STATE OF ABANDON HOUSE SEWER
NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEED RESIDEN IAL ROPERTY. BACKFILL SEPTIC TANKS❑'
SEEP.PITS ❑ CESSPOOLS❑
REMITTE
®p VALIDATIO ROBERT A.WOOD
CK. M.o. CAGB SUPERVISING MECHANICAL ENGINEER
�f 3 i 9 2 SES 25 1 ,0 A 5.00' •m .1