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HomeMy Public PortalAbout9419 LEMON AVE_Sewer__ D IS&E-683 11•SS �APPLICATION FOR PERMIT S 8:E•8 DIVISION OF BUILDING" AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING r JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS s ® CASSATT D GRIFFIN, SUPT OF BUILDING - LOCALITY FPR APPLICNEAREST 01 �,n TO FILL IN CROSS ST. LEGL DESCRIPTION LOT NO:r, / OWNER SS,,,, ry BLOCK TRACT ADDRESS O'C t� t T" _ I NO.OF BLDGS. CITY TEL. NO. SIZE OF LOT Q, ..� 1)0 NOW ON LOT USE OF BUILDINGS DISTRI O. GP I MAP BK PG CONTRACTOR :2_0 ADDRESS 0NNECTION DATA STATION DEPTH CIT TEL.NO. MANHOLE EFER N PER , ❑ STATE REGISTRA ION NO. ,� (d ❑ COUNTY No, DESCRIPTION OF WORK FEE t HOUSE SEWER CONNECTING TO TYPE OF CO CP L M L. TO P L. TION LENGTH FROM-- L p PUBLIC SEWER @ $3 50 S© Y. RB • �, SEPTIC TANK,SEEPAGE PIT OR _ �p PITS AND/OR DRAINFIELD Q $3 00 =---t�. - P''G�� --- --- OVERFLOW SEEPAGE PIT, DRAINFIELD (/ .32 EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $ 2 00 CO IMP NO. JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK,PERMIT NO. ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR j,5> STATE ENCROACHMENT WORK TO HOUSE SEWER Q $ 1 00 � PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNERS PERMIT 5 1 00 AUTHORIZATIONITOTAL FEE1-6 L�— REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 4( TO THE PUBLIC _ NEW HOUSE SEWERAl d SIGNED THISADP,Y OFy 1J 7 CONNECT ADDITIONAL OWNER OR- BUILDING OR WORK OWNERS AGENT r SEPTIC TANK,SEEP,PIT(S) `ADDRESS . > AND/OR DRAINFIELD a, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑- AND 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 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 PROPER T BACKFILL SEPTIC TANKS❑ I SIGNATURE �`S, SEEP PITS) ❑ CESSPOOLS OF PERMITT I6_ _ _ JOHN A LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A WOOD. CHIEF PLBG INSPECTOR CK H O CASH 5 2 3-6- FEB 155- -4 - 6.50 -In- 246SO INSERTS ' 76AG42D APPLICATION FOR PER-MIT 6A842D COUNTY OF LOS ANGELES ' y SE1A/ER-SEVI/AGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST71 JOHN A. LAMBIE, County En eerWILLIAM A. JENSEN, Supt of Building FOR APPLICANT TO FILL IN . LEGAL r� �yYS DESCRIPTION LOT N0. G/��p _? OWNER BLOCK - TRACTT 'MAIL.� ADDRESS SIZE OF LOT NOW ON LOTS CITY Q TEL. NO , USE OF DI DISTRICT NO. GROUP MAP PRO SSED BY BUILDINGS /l ' CONTRACTOR h /v/ PG ADDRESS (I CONNECTION DATA CITY L.N0. STATION �- DEPTH �J STATE MANHOLE REFERENCE UPPER REGISTRATION NOCOUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 00 - TYPE OFC NN LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $ 00 OVERFLOW SEEPAGE PIT DRAINFIELD - EXTN CESSPOOL DRYWELL @ $ 00 , HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $ 00 CO IMP NO. JOB NO. a CONNECT ADDITIONAL BLDG OR TRUNK PERMIT N0. ROAD PERMIT N0. V WORK TO HOUSE SEWER @ $100 ALTER R DAIRO R ABANDON SYSTEM HOUSE @ $ 00 STATE ENCROACHMENT pq PERMIT NO INDUSTRIAL W WASTE APPROVAL W CHARGES OWNER'S 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 _VATE1 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 ' 1 HEREBY ACKNOWLEDGE THAT 1 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 DISCONNECT PLUG AND _ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER - - CALIFORNIA OR THAT M THE LEGA W ON OF THE ABOVE DESCRIBED RESIDENT L ROPERTY. ' BACKFILL SEPTIC TANKS ❑ SIGNATURE SE6E.PIT(S) ❑ CESSPOOLS _• OF PERMITTE . OF VAUMATION ROBERT A. WOOD Y.0. CASH SUPERVISING MECHANICAL ENGINEER LAC,:):L .5 a APR 2 4 1 v, D 7.0 0tD 2 /t� 46IN CE6066- 76A842D 60 APPLICATION, FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ggi�nn 'ADDRESS WILLIAM'A IENSENCSu'of Buildei_g P LOCALITY NEAREST- FOR APPLICANT TO FILL IN CROSS ST. LEGAL i DESCRIPTION LOT ND.� OWNERMAIL • BLOCK TRACT J /' 'ADDRESS NO OF BLDGS. SIZE OF LOT NOW ON LOT / CITY EL NO USE OF BUILDINGS DISTRICT NO. GROUP •BK MAP P6• CESSED BY CONTRACTOR �/�� I ADDRESS �¢ �� / (J CONNECTION DATA CITY:�7 NO. r fL� STATION DEPTH ' STATE MANHOLE REFERENCE f -UPPER REGISTRATION NO Q—/ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO _ PUBLIC SEWER @ $ 00 CON C LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. C P.L. M.L.TO P.L. .�• ITS AND/OR DRAINFIELD @ $ 00 - OVERFLOW SEEPAGE PIT, DRAINFIELD ' EXTN CESSPOOL DRYWELL @ S 00 HOUSE SEWER CONNECTING TO P.C.N0. _ PRIVATE DISPOSAL SYSTEM @ $ 00 CO IMP. NO. JOB N0. �. a CONNECT ADDITIONAL BLDG. TRUNK PERMIT NO. ROAD PERMIT NO. �IVIV WORK TO HOUSE SEWER @ E 00 ' ALTER, REPAIR OR AB ND SE STATE ENCROACHMENT pq SEWER OR DISPOSAL S @ .00 PERMIT NO. O INDUSTRIAL WASTE APPROVAL CHARGES - OWNERS PERMIT $ CONNECTION CHARGE FEE _ - AUTHORIZATION TOTAL FEE 41V REIMBURSEMENT FEE I HAVE AT THIS DATE A-CONTRACT WITH THE HEREIN NAMED CON- "f TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAIS DATE INSPECTOR'S SIGNATURE, TO THE PUBLIC SEWER. �'j' .• SIGNED THIS—! Y•O 19_ NEW HOUSE SEWER !7 - - ? OWNER OR OWNERS AGENT- )� BUILDING ADDITIONAL ORDWORK ADDRESS SEPTIC TANK,SEEP.PITS) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE•THAT 1 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 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED,BY LOS ANGELES COUNTY-AND STATE OF ABANDON HOUSE SEWER' CALIFORNIA OR THAT 1 A THE LEGA OW T E ABOVE - DESCRIBED RESIDENTIAL OP RTY. BAC ILL SEPTIC TANKS ❑ _ SIGNATURE - - _ SEE PITS) ❑ CESSPO LS OF PERMITTE • - , ROBERT A. W OD CK. H.D,, CASH _ SUPERVISING MECHANICAL ENGINEER - : Lko1585 APR 2'4 2 D 25.00- to TEMPLE CITY E808 ° Ceeoe - APPLICATION FOR PERMIT a-na COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADDRESLDINGS MBffi JOHN A. LAIE, County Engineer CASSAIT D. GFFIN, Supt o4 Building LOCALITY NEAREST FOR APPLI T FILL CROSS ST. , LEGAL — OWNER C DESCRIPTION J LOT N0. ' BLOCK TRAC MAILADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. i 19(a USE OF, BUILDINGSDISTRICT NO. GROUP MAP PRO ESSED BY BK PG CONTRACTOR � ADDRESSCONNECTION DATA CITY STATION L- DEPTH 8STATE MANHOLE REF E NCE -UPPER REGISTRATION NO, COUNTY NO. 1 DESCRIPTION OF WORK FEE , HOUSE SEWER CONNECTING TO i •- PUBLIC SEWER @ $3.00 TYP OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS 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. NO. JOB WORK CONNECT ADDITIONALOUSE BLDG.OR - @ $1 OO TRUNK PERMIT NO. OAD PERMIT N0: , EWEABANDON HOUSE @ 0 STATEENCROACHME - PERMIT NO. INDUSTRIAL WASTE A OVAL CHARGES OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE NMED CON- TRACTOR TO CIONNE T THE ABOVE ESCR BED EXISTDATE A CONTRACT WIH THE IINGADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC S ER. SIGNED THIS DAY 11h4 ajdAI9 NEW HOUSE SEWER OWNER OR O CONNECT ADDITIONAL OWNERSAGENTi BUILDING OR WORK ADDRESS—&j SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE AD 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND, LICENSED AS, REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDOBACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDE L OPERTY. (' SEEP PITS ❑ CESSPOOLS SIGNATURE OF PERMITT0 E - y ALMATION ROBERT A. WOOD _ M.G. CASH SUPERVISING MECHANICAL ENGINEER In L � av - �9 a 5 0 .� iu�R ?� 2 G G 3.00 vi r.