HomeMy Public PortalAbout9854 LEMON AVE_Sewer__ 78A6
42D ,,, tPPLICATIOMFOR PERMIT �S-
S 8 E-669 11-E5
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL,
Department of County Engineer
County of LOS Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS v�✓ci-
® CASSATT D GRIFFIN, SUP T OF BUILDING 'LOCALITYNEAREST
/��, �➢
FOR APPLICANT .TO FILL IN CROSS ST. �.
LEGAL
DESCRIPTION LOT-NO OWNER
MAIL j e
BLOCK TRACT ADDRESS �J .
NO.OF BLDGS CITY TEL NO
' SIZE OF LOT - NOW ON LOT
USE OF1-
BUILDINGS 141 DISTRICT NO GROUP MAP
BK PG
CONTRACTOR
ADDRESS_ CONNECTION DATA69
0
STATION DEPTH
CITY TEL. N0. f� j MANHOLE R ERENCE
STATE � 'LOWER
REGISTRATION NO.Z �( COUNTY
NO DESCRIPTI N Or WORK FEE
TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P L. M L. TO P.L. 17
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR ,
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD P C NO.. ��
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO. IMP. NO. JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S pERMT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE _ YY'/7"0PZ~ V'd 9 b CSJ'
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER `
SIGNED THIS-DAY OF 19 CONNECT ADDITIONAL
OWNER OR - BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
'ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE 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 _
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT AM THE LEGAL OWNE OF THE ABOVE
DESCRIBED RESIDWER
EN ROPERT BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP.PITS) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LA IE. C NTY ENGINEER VALIDATION ROBERT<A WOOD, CHIEF PLBG INSPECTOR ;
CK. M O.M2 9 4. 6 Jm 1-'7 10 A 4.50