HomeMy Public PortalAbout9414 LEMON AVE_Sewer__ 7&E E-1963 9-88 'APPLICATION Y OR PEF�MIT
8& •88
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer ligmig
County of Los Angeles BUILDINGr/ ,� O
WM.J. FOX, COUNTY ENGINEER ADDRESS Z
-CABSATT D.GRIFFIN, SUPT or BUILDING LOCALITYNEAREST �'_y�'x'11►, `Q /�
FOR APPLICANT TO FILL IN CROSS ST. �/ �/`t
LEGAL �p0 ,
_DESCRIPTION LOT NO.T�L t ��< iyef!l) NI 'OWNER S��� ko G�J
BLOCK TRACT SAM AIU' MAIL
i'+^ "+ ADDRESS
Sc
NO OF BLDGS.
SIZE OF LOT NOV; ON LOT CITY TEL. NO
USE OF mm -
BUILDINGS UY Q S �/,j/p_ DISTRICT NO. GROUP _ MAP
BK` PG'
CONTRACTOR /•,r,��� ap ' e
ADDRESS —� N w I Loa,_ CONNECTION DATA
CITYS TEL NO. STATION DEPTH
• ��� TATE MANHOLE REFERENCE,/,),17 Q � UPPE
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM L
HOUSE SEWER CONNECTING TO 1,Y? CURB •4LL° M.L. TO P.L
PUBLIC SEWER Q $ 3 50 _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 _
CONNECT ADDITIONAL BLDG. OR P C NO
WORK TO HOUSE SEWER 1 00 CO. IMP. NO. t�fF.- JOB^NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO, ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYW ELL WASTE APPROVAL,
SPECIAL CONDITIONS ONLY 2 00 CHARGES
pElil�lllT CONNECTION CHARGE FEE
OWNER'S S 1 00
AUTHORIZATION I TOTAL FEE _j-® REIMBURSEMENT FEE
I HAVE DATENMED CON-
TRACTORTHIS To CONNECTO THE ABOVE DESCR BEDWITH THEH EREIN EXISTINGq DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER /
SIGNED THIS ai^/�DAY OF 1 1 9157 ' NEW HOUSE SEWER
OWNER OR '✓ i(I 1i r CONNECT ADDITIONAL -
OWNERS AGENT 1•+ BUILDING OR WORK
ADDRESS yqVf SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY_ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL EDDRYWELL[:1AND 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 REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER'
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[; P
SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE ,
WILLIAM J.FOX.COUJI ENGINEER VALIDATION R. A.WOOD, CHIEF PLBG. INSPECTOR
_.ACo6 9 4:9AUG 22 4 :," 5.5 7 In .
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