HomeMy Public PortalAbout9401 LEMON AVE_Sewer__ D
CE808 APPLICATION FOR PERMIT
eaoa a-ae COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRES
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup t of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL r,�, - ;f' OWNER
DESCRIPTION LOT N0. -
MAIL
BLOCK TRACT ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP I PROCESSED BY
.r BK PG
CONTRACTOR •�,, �.� i,3�
Y'`
ADDRESS CONNECTION DATA
CITY TEL.NO. STATION/,)-,/ " � � DEPTH
STATE MANHOLE REFERENCE /' UPPLR
REGISTRATION NO./ COUNTY �:; �,. 1ugvmw
NO. DESCRIPTION OF WORK FEE
r
HOUSE SEWER CONNECTING TO !
PUBLIC SEWER (') $3.00 TYPE OF_CGNNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB t P.L. M.L.TO P.L. ,_3
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO ..• P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. .r' JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER (@ $1.00
ALTER, REPAIR OR ABANDON SEWER OR DISPOSAL SYSTEM HOUSE @ STATE ENCROACHMENT
$I 00
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS ❑
OF PERMITTEE
OF VALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER