HomeMy Public PortalAbout9858 LEMON AVE_Sewer__ S&E-6 911.55 APPLICATION! FOR PERMIT
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE-DISPOSAL
Department 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 OWNER
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT i� ADDRESS
i
N0,OF BL X CITY TEL. NO.
SIZE OF LOT NOW ON LOTTS'
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
y BK PG
CONTRACTOR G' - p .7L
ADDRESS
CONNECTION DATA
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STATION �''t` O DEPTH
CITY TEL. NO.
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MANHOLE REFERENCE J r
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REGISTRATION NO. - -�F NVU"H ❑ COUNTY
ION O K FEE
No. DESCRIPTION
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM '
�'b Y, CURB P.L M.L.TO P,L.
PUBLIC SEWER @ $3 50 _
SEPTIC TANK,SEEPAGE PIT OR ,
PITS AND/OR DRAINFIELD @ $3 00 —
OVERFLOW SEEPAGE PIT, DRAINFIELD 'PSC• NJ
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO. IMP NO. 7II8'Rc
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 PERMIT
AUTHORIZATION TOTAL FEE* 1 510
REIMBURSEMENT FEE
1 HAVE AT THIS DATE CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTORS SIGNATURE'
TRACTOR TO CONNEC THE ABOVE DESCRIBED EXI ING DWELLING
TO THE PUBLIC S NEW HOUSE SEWER A.
SIGNED THIS DAY O 19 CONNECT ADDITIONAL
OWNER OR I L� BUILDING OR WORK
OWNERS AGENT _ SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTER AND/OR DISCONNECT PLUG AND
LICENSED AS RE RED Y LAOS A` ELES CO Y AN TE
�4�L,,��F�QQR A OR 1 TH L GAL 0 0 ABANDON HOUSE SEWER
D�BF�Ip DR V, P BACKFILL SEPTIC TANKS❑
Sff//G��N A�/7URE f SEEP PIT(S) ❑ CESSPOOLS❑ p
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK N 0, GASH -
2 5 '2 4 °; APR 1 4 A - 5-50