HomeMy Public PortalAbout9860 LEMON AVE_Sewer__ EBOS-8
CAPPLICATION FOR PERMIT
eeoe-e-ss COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ;NEARESTLDING
RES3JOHN A. LAM M Countp,Engineer
CASSATT D. GRIFFIN, Supt of Building ALITYFOPPLICANT TO FILL IN ss.sT. e�461_tA4'1792-4aDESCRG TION LOT N0.n " ER444 Z
BLOCK MAIL
'ADDRESS 'p
NO.OF BLDGS.
SIZE OF L07 NOW ON LOT CITY EL.N0.
USE OF
BUILDINGS DISTRICT-NO. GROUP BK MAP PG PROCESSED BY
CONTRACTOR Able onatr.e -
ADDRESS 225 W Bryant Rd CONjqErTTnTq DATA
CITY 1 Mont e TEL.N0. Gi $�6 6 STATION Q DEPTH
STATE
REGISTRATION NO. 9 B COUNTY MANHOLE REFERENCE i �Y PPER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO L�V
PUBLIC SEWER @ $5.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L.j M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 '
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @1.00 CO IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER 0 $1.00
ALTER, REPAIR
DISPOSAL SYSTEM R ABANDON HOUSE @ $1.00 r STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 CO CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING Q
TO THE PUBLIC SEWER. NEW HOUSE SEWER : -3' C�1JX%
SIGNED THIS SAY OF 19-
OWNER OR CONNECT ADDITIONAL " O
OWNERS AGENT_� BUILDING OR WORK Q
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE. READ THIS.APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
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 b
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL 0 N OF THE ABOVE I
DESCRIBED REST IAL PROP TY. BACKFILL SEPTIC TANKS [ISEEP.PIT(S) ❑ CESSPOOLS ❑
SIGNATURE
OF PERMIT
®a ` ' TMMATION ROBERTA.WOOD
Y.o. CASH SUPERVISING MECHANICAL ENGINEER
��C0 1 4'6�. t4k')` 2 1 0 -A 5 r 0