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HomeMy Public PortalAbout9418 LEMON AVE_Sewer__ 7CE808 3- 6A642D62 APPLICATION FOR PERI I COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building E LOCALITY NEAREST FOR APPLICANT TO FILL IN CRD95 ST LEGAL . DESCRIPTION LOT NO. S Q OWNER ' K MAIL BLOCK TRA.T_TA4ir,4 /TA I-AAIb co, ADDRESS NO. OF BLDG.. !� SIZE OF LOT NOW ON LOT CITY EL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESS D BY T BK PG CONTRACTOR © a / ADDRESS J� CONNECTION DATA CITY TEL. NO. STATION ;1- DEPTH 9 1 STATE MANHOLE REFERENCE REGISTRATION NO. COUNTY 2- LOWER NO. DESCRIPTION OF WORK FEEPE OF CONNECTION LENG FROM _ } HOUSE SEWER CONNECTING TO Y. CURB P.L. 0 PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR 1,/ P.C.NO. V PITS AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. O PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVEI EASEMENT RECORD, INSTR,NO, DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL,DRYWELL.MANHOLE @ $5.00 y ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING Z SEWER OR DISPOSAL SYSTEM @ $3 O STATE ENCROACHMENT PERMIT NO. INDU RI CHARGES OWNERS PERMIT $ 2YO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE I NSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER ' OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIA PROPERT . ABANDON HOUSE SEWER SIGNATURE / OF PERM ITTEE� 4�C BACKFILL SEPTIC TANKS ❑ SEEP,PITS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.O. SUPERVISING MECHANICAL ENGINEER CASH 42D 10-63 76A66A64APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE_DIS OSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING a ,/ JOHN A. LAMBIE, County Engineer ADDRESS V WILLIAM A. JENSEN, Sup't of Building / LOCALITY p v` NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO 6 OWNER ` ` MAIL BLOCK TRACTSefi"r 1 D L..XJ ADDRESS "&- M NO OF BLDGS SIZE OF LOT NOW ON LOT CITY `j EL NO USE OF BUILDINGS DISTRICT NO GR UP MAP PROCESSED nn 1 BK PG CONTRACTOR ' ��1 �,� li / ADDRESS CONNECTION D TA CITY P,16&TEL NO Z STATION DEPTH 1 [' ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO �J ❑ COUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER @ $5 00 PC NO SEPT f TANK SEEPAGE PIT OR JOB NO O PITS ND/ OR DRAINFIELD @ SIO 00 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ S300 /1 CONNECT ADDITIONAL /� AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE V WORK TO HOUSE SEWER $3 00 f• OVERFLOW SEEPAGE PIT,DRAINFIELD '� LLI EXTN CESSPOOL,DRYWELL,MANHOLE @ $5 00 CL ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO J INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s 2 00 AU'T'HORIZATION I TOTAL FEE or/ CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA//MED CONN REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR 5 SIGNATURE SIGNED THIS DAY OF )9 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK • j SEPTIC TANK,SEEP,PITIS) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF S EWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE D}}}fffESCRI/B�F�j RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE // �Y ! /�� �O 1, OF PERMITTEE {/-f�y� J ( (J BACKFILLS EPTIC TANKS ❑ SEEP PITIS) ❑ CESSPOOLS ❑ �ycc.ct+ sZ z•c�E.,�$LIDATION ROBERT CK M o CASH SUPERVISING MECHAA WOODNICAL ENGINEER L 9 5 8 9 U NA,1 15 1 0 D 5.0 0— 0-63 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER FM BUILDING AND SAFETY DIVISION BUILDING I f� JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt o4 Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROS ST LEGAL _Z DESCRIPTION LOT NOnOr �/', 0 (� OWNER / �,/� BLOCK TRAC ' '4A). (� ADDRESS IVL NO OF BLDGS /A. 1 ^f SIZE OF LOT NOW ON LOT CITY � /e v/,/ TEL NO / USE OF' I BUILDINGS C� DISTRICT NO GROUP MAP PRO SSED BY CONTRACTOR BK � A <d � Z s- /jPG ADDRESS -, `E,4 6.41 CONNECTION'] CITY L Le EL NO /' 71977 STATION DEPTH HT SATE MANHOLE REFERENCE REGISTRATION NO L� COUNTY ._, S2(, LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y 41-1 CURB P L ML TO P L d PUBLIC SEWER @ $5 00 /� J /Q P C NO _ O SEPTIC TANK,SEEPAGE PIT OR PITS ANO/OR DRAINFIELD @ $1000 CO IMP NO JOB NO C V HOUSE SEWER CONNECTING TO TRUNK PERMIT ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ S300 0 CONNECT ADDITIONAL BLDG OR v^ AFFIDAVIT WAIVER 1'113NrNT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 V OVERFLOW SEEPAGE PIT DRAINFIELD 11J EXTN,CESSPOOL.DRYWELL.MANHOLE @ $5 00 a ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT z PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNAT RE SIGNED THIS DAY OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK ` U SEPTIC TANK,SEEP,PITS) f, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO ISCONNECT PLUG AND RESIDE IN, THE ABO DESCRIBE REST 29�.' BANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTE ❑ SEEP PITS) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER L�1Lo 0 9 7 6 i,PR 2 0 1 0 D 5.00- 76AC420 APPLICATION FOR PERMIT S 6:E•663 11.55 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Depcatm�eat of County Engineer �p County of Los Angeles BUILDING . 401770/'! /`f Ile JOHN A LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN, SUPT of BUILDING LOCALITY �/ FOR APPLICANT TO FILL JL IN ceos5 ST.LEGAL O DESCRIPTION LOT N0. "4 S/�"r �Q' OWNER �P 6e� •�i ��Cj ' L / 6� 6 MAIL 48 E, I e,0617 /7 de' BLOCK TRACT 61- r(,� ADDRESS J - NO. O&BLDGS CITY��� �e C�• TEL NO.��-7-X97/ SIZE OF LOT NOW LO USE OF BUILDINGS DISTRICT NO GROUP MAP CONTRACTOR _ S� PG ADDRESS CONNECTION DATA STATION I/ DEPTH , CITY TEL. NO. MANHOLE REFERENCE - UPP ❑ STATE / LOWER REGISTRATION NO, ❑ COUNTY _NO. DESCRIPTION OF WORK FEE - d HOUSE SEWER CONNECTING TOTYPE OF CONN ON LENGTH FROM , / PUBLIC SEWER @ $3 50 Y. CURB P L. ,M L TO P,L - SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT,DRAINFIELDP. C. N0. EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP. N0. -4 JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK'PERMIT NO ROAD PERMIT NO. CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER Q $1 00 _PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL CHARGES OWNERS pEIMUT S 1 00 CONNECTION'CHARGE FEE , AUTRORIZATION TOTAL FEE REIMBURSEMENT FEE_� I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS_ DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER'. NEW HOUSE SEWER - �q tl�•+r i�'�'� SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR 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 ABOVEJSCORRECT AND AGREE TO COMPLY WITH Aft 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 A OVE - - DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑` SIGNATURES SEEP.PITS) ❑ CESSPOOLS OF PERMITTEE„ i JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR CK m 0 CASH