HomeMy Public PortalAbout9417 LEMON AVE_Sewer__ �246IIySF,RTS,.
'CES O8APPLICATIOIV � I°OR PERMIT .
78A8421)2D COUNTY OF LOS ANGELES SEWER-_SEWAGE -DISPOSAL_, -
- DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING _
ADDRESS
JOHN A. LAMMIE, County En eer
WILLIAM L JENSEN. Supt of Building LOCALITY
NEAREST "
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL - '
DESCRIPTION LOT NO. / /BTL / OWNER
BLOCK TRACT, 7�7 ADDRESS
NO OF BLDGS. _
SIZE OF LOT NOW ON LOT CITY d TEL NO.
USE OE DISTRICT NO. GROUP MAP P SSED BY '
BUILDINGS
BK P6
CONTRACTOR /yy
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ADDRESS CONNECTION DATA,
CITYTEL.NO. f STATION DEPTH
Jol ,�pper� STATE MANHOLE REFERENCE - UPPER
REGISTRATION NO �/"t'• COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ 00 TYP CONN 1 LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y. OL. M.L.TO P.L. -
PITS AND/OR DRAINFIELD @ $ 00 U_j
OVERFLOW SEEPAGE PIT,DRAINFIELD - -
EXTN CESSPOOL DRYWELL @ I z 00
HOUSE SEWER CONNECTING TO P.C. O.
PRIVATE DISPOSAL SYSTEM @ $ 00 CO IMP. NO JOB N0. y.
WORK
CONNECT
D ADDITIONAL BLDG.OR @ $ OO TRUNK PERMIT NO. ROAD PERMIT NO. L 0
V
ALTER,R PAIRO R ABAND OUSE @ 1 00 STATE ENCROACHMENT _ iii
SEWPERMIT NO. �0
INDUSTRIAL �V
WASTE APPROVAL a
CHARGES
OWNER'S PERMIT $ CONNECTION,CHARGE FEE -
AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING •- APPROVALS DATE 'INSPECTOR'SSIGNATURE
TO THE PUBLIC SEWER. ��
SIGNED THIS DAY OF 19= NEW'HOUSESEWER �t �'•� :.7,� ��, r� y
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY'ACKNOWLEDGE THAT IHAVE 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES C NTY AND STATE OF ABANDON HOUSE SEWER `
CALIFORNIA OR THAT M THE LEG - W OF THE ABOVE ,
DESCRIBED RESIDENT L YROPERT BACKFILL SEPTIC TANKS ❑.
SIGNATURE SEEP. PIT(S) ❑ CESSPO21i ❑
OF PERMITTE
®P ALIDAT ON ROBERT A. WOOD -
cX
M.-O. CASH SUPERVISING'MECHANICAL ENGINEER,
'�'�1 5 8 3 APR 2-4 1 1 'D 2 5.0 0
_ • c � - � ����- ,��� 2465E��1IySERTS.�������� •
CE808 6.60
+76A642D APPLICATION FOR PERMIT' - .•1i. ,
,r
COUNTY OF LOS ANGELES SEWER—, .SEWAGE ®,ISP®SAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING77:
ADDRESS. G
s IOHN A. LAMBIE, County Engineer
WILLIAM A. IENSEN, Supt of Building LOCALITY
NEAREST '
FOR APPLICANT TO 'FILL IN' CROSS ST. -42 V,
-'"LEGAL OWNER
DESCRIPTION LOT N0.,� -
BLOCK " TRACT MAIL
ADDRESS
NO OF BLDGS. '
SIZE OF LOT NOW ON LOT 'CI EL N0.
USE DI - DISTRICT NO. GROUP MAP SSED.BY
OF
BUILDINGS BK PG `
CONTRACTOR 1IV
�
-ADDRESSQ , �- CONNECTION DATA
STATION` DEPTH -
� "TATE MANHOLE"REFERENCE PPER i
REGISTRATION N0. / w�o� ❑ COUNTY
NO, - DESCRIPTION-OF WORK FEE v,
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $ 00 - TYPE F CON C - LENGTH FROM _ '
SEPTIC TANK,SEEPAGE PIT OR Y. P. M L.TO-P.L. - - "
PITS AND/OR DRAINFIELD @ $ '00
'! OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL @ $ 00 -
HOUSE SEWER CONNECTING TO P.B . - _
PRIVATE DISPOSAL SYSTEM - @ $ 00 CO IMP. N0. JOB NO. y�
CONNECT ADDITIONAL BLDG.OR
WORK"TO HOUSE SEWER @ $ 00 TRUNK PERMIT NO. ROAD PERMIT N U
ALTER, REPAIR OR ABANDON'HOUSE STATE ENCROACHMENT ' al
• SEWER OR DISPOSAL SYSTEM _@ 00 PERMIT NO O
INDUSTRIAL V
• WASTE APPROVAL
• - CHARGES - U1
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE `REIMBURSEMENT'FEE
-1 HAVE AT THIS-DATE A CONTRACT WITH THE HEREIN NAMED CON-
T
RACTOR-TO CONNECT'THE-ABOVE ,DESCRIBED'EXISTING DWELLING " 'APPROVALS ''iDATEOr 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.PITS)
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
PLUMBING-AND SEWERS. - _.ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 'AM PROPERLY REGISTERED AND/OR SEWAGE
DISCONDISPOSALECT'PLUG AND '
LICENSED AS'REQUIRED BY LOS ANGELES COUNTY AND OF ABANDON HOUSE SEWER - - •-
CALIFORNIA, OR" THAT '1 THE LEGAL OWNER OF THE, ABOVE - V '
DESCRIBED RESIDENT, P PERTY. BACKFILL,SEPTICTANKS ❑
SIGNATURE - _ S .,PIT(S) ❑ CESSP OLS ❑
OF PERMITTEE
®F - - ATION - ROBERT A. WOOD• -
cIC. - H.0. _ °CASH SUPERVISING MECHANICAL ENGINEER
Y , ? 1 :5 8 2 APR 4,1 D