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HomeMy Public PortalAbout9420 LEMON AVE_Plumbing__ 0-63 76A642 D APPLICATION FOR PERMIT 6A642 - COUNTY OF LOS ANGELES SEWER-SEWA EDI SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. IENSEN. Sup't of Building LOCA LiTY NEAREST FOR APPLICANT TO FILL IN CRO 55 ST. _ LEGAL DESCRIPTION LOT NO. �' A� Ct Z OWNER MAIL BLOCK TRACT ,� �kDDRESS NO. OF BLDG5. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICTNO. GROUP MAP PROCESSED BY BUILDINGS BK PG J CONTRACTOR ADDRESS v ©r f CONNECTION DATA ` / �O STATION DEPTH CITY TEL...ANO. V ❑ COUNTY MANHOLE REFERENCE REGISTRATION NO. gg..'� i LKS j, LOWER NO. GESCRIPTIO OF WORK FE -�YPE OF CONNEBCTIO LENGTH FROM HOUSE SEWER CONNECTING TO CURP.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 P.G.NO. d SEPTIC TANK,SEEPAGE PIT OR PITS ANO/OR DRAINFIELD @ $10.00 CO. IMP. NO. JOB NO. r O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 0. CONNECT ADDITIONAL BLDG.OR AFFIDAVIT VIAIV ER EASEMENT RECORD, INSTR, NO, DATE O WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD V E%T N..CESSPOOL,DRYWELL.MANHOLE @ $5.00 W ALTER. REPAIR OR ABANDON HOUSEHWY,OR ST.WIDENING , ,"_+ �' (CL SEWER OR DISPOSAL SYSTF-M- @ $3.00 STATE ENCROACH ME r Z PERMIT NO. Vp INDUSTRIAL C WASTE APPROVAL ' d OWNERS PERMIT ��-•"".'.., . $ 2 00 CHARGES AUTHORIZATION TOTAL FEE / CONNECTION CHARGE 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 INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS- BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED'AND/0 . ALTER, REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES C0(JNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT AM T E LEGAL OF, At�D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB IBE E IA R ERT Y. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE _ SEEP,PIT IS ❑ CESSPOOLS ❑ 0CK. VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER p � r 3-64 76A643-64 APPLICATION FOR RMIT 6A64 COUNTY OF LOS ANGELES SEWER—SEWAtgE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL j DESCRIPTION LOT NO OWN MAIL /70 ,3 S BLOCK TRACT ` ADDRESS NO OF BLDGStom/ / SIZE OF LOT NOW ON LOT CITY aJ , TEL NO 6 USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY BK PG CONTRACTO A a 1� 0'464-t�lt ADDRESSdI' YZfCONNECTION DATA C Y EL NO © STATION DEPTH 3 TE MANHOLE REFERENCE / f UPPER REGISTRATION NO C// �� COUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO OD Y CURB L M L TOP L PUBLIC SEWER ES 00 SEPTIC TANK,SEEPAGE PIT OR P C NO / a PITS AND/OR DRAINFIELD @ $1000 CO IMP. NO JOB NO / HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM $300 U CONNECT ADDITIONAL BLDG OR AFFIDAVIT I %'AIV[[I [A[[M[NT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 / O OVERFLOW SEEPAGE PIT,DRAINFIELD l A J EXTN,CESSPOOL,DRYWFLL.MANHOLE @ $5 00 U ALTER,REPAIR OR ABANDON HOUSE O T. IDENINO W SEWER OR DISPOSAL SYSTEM $300 a STATEENCROACHMENT N PERMIT NO. Z INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT s 2 00 AUTHORIZATION I TOTAL FEE 7 OD CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WI H THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CON" EC HE ABOVE DES XISTING ELLIN TO THE PUBLIC SEW APPROVALS DATE INSPECTOR'S SIGN T RE SIGNED THIS DAY OF 1 �A OWNER OR NEW HOUSE SEWER OWNERS AGENT - CONNECT ADDITIONAL BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY AT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR SEWER OR LICENSED AS REOUIR BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THA AM THE EGAL OWNER OF, AN INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AS E DESCR D RE I NTIALL�PR TY ABANDON HOUSE SEWER SIGNATURE {�- ❑ OF PERMITTEE BACKFILL SEPTIC TANKS SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK M O SUPERVISING MECHANICAL ENGINEER CASH Lhiluc 0 3 3 7:3 rFR 7 1 0 D 7.0 ON