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HomeMy Public PortalAbout9433 LEMON AVE_Sewer__ R ti 0-63 7BA642D APPLICATION FOR PERMI 8A642 �J COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7.11NElle- MAIL JOHN A. LAMBIE, County Engweer 33 v Q WILLIAM A. JENSEN, Sup't o4 Building / FOR APPLICANT TO FILL IN A. LEGAL y.e 'DESCRIPTIONW �a ^ ✓ BLOCK T ADDRESS Y O f J t SIZE OF LOT 'NO NOWCONSLDGS LOT CITY T / L NO 6r USE OF BUILDINGS DISTRICT NO GROUP MAP PROCES D BY , /� BK PG CONTRACTOR r P Q' Q f �/ 09 j 2- 0 ADDRESS (� Ce Rve, CONN CTION DATA STATION DEPTH CITY 1 TEL NO �" D f It S ❑ TATE MANHOLE FER CE U ER REGISTRATION NO ❑ COUNTY ER NO DESCRIPTION OF WORK FEE NECTION LENGTH FROIA HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L d PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR J O NOOB NO O PITS AND/OR DRAINFIELD @ S1000 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 ^ CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 u OVERFLOW SEEPAGE PIT,DRAINFIELD LIJ EXTN CESSPOOL,DRYWELL,MANHOLE @ $5 00 a' ALTER,REPAIR OR ABANDON HOUSE HWY ORST WIDENING h Z SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL � CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE ..1 CONNECTION CHARGE 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 SE 'F�R�. APPROVALS DATE INSPECTOR 5 SIGNATURE SIGNED THIS �/ DAY OF 1 OWNER OR NEW HOUSE SEWER ADDRESS 4! OWNERS AGENT /!y'�` CONNECT ADDITIONAL /1 �} �_fJ BUILDING OR WORK I ��cl��-�+ , SEPTIC TANK SEEP PIT(S) I HEREBY 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 CESSPOOL ❑ DRYW ELL ❑ PLUMBING AND SEWERS I HEREBY CERTIFY THAT I 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 I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE 0 DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE ('�(�/J BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(5) ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD cK M O ! CASH SUPERVISING MECHANICAL ENGINEER L;�07 11 0 5 DEC 24 1 0 D 5.00- N DEPARTDIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING / WILLIAM J. FOX, COUNTY ENGINEER ADDRESS /'�e 4 ' - 1 FOR APPLICANT TO FILL IN LOCALITYBUILDIADDRESS 4VAI-q �1 NEAREST ADDRESS i� �J CROSS ST. LOCALITY +���� DIST NO AA SERIAL N0. PERMIT(p^ J N0. C NEAREST /� CROSS ST. -- CE VED Y Ready for Inspection DATE ISS ED OWNER ��.(�� ' '�3 j - SS MAIL e� USEtZONE OCCUPANCY MAP ADDRESS �.�I I -;) /�•"'- v I BK PG CITY TEL.NO. CONTRACTOR%,. � ��� . CO.IMP.NO. /32.$ ' �r ADDRESS CITY A ,n TELAO. TRUNK PERMIT NO. REGISTRATION-NO. �STOUNATE ROAD PERMIT NO. LEGAL ATE ENCROACHMENT DESCRIPTION�• LOT NO. 60--eP IT NO. BLOCK TRACT ��� /3� INDUS L / / T se77 WASTE AP VAL SIZE OF OF LOTT C x�NOW ON LOTS' LJ k�NOW ON LOTS L-- CHARGES USE OF BUILDINGS CONNECTION CHARGE F NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE _ PUBLICSEWER @ $ 3.60 RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 s` NO. - ALTER OR REPAIR EXISTING DATE BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION /O /a DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 //OI MANHOLE REFERENCE L0E TYPE CTION LENGTH FROM OWNERS PERMIT $ 1 v. cuss P.L. M.L.TO P L. 3.S 00 AUTHORIZATION I TOTAL FEE 1 6150 HAVE 1CO TRACTOIS DATE R TO CONNECT THTED W TH THE E ABOVN NAED 11E D SCRIBEDIEXISTING APPROVALS INSPECTOR'SSIGNATURE DATE DWELLING TO THE PUBLIC SEW SIGNED THIS-- DAY OR Iq NEW HOUSE SEWER,, OWNER OR /O CONNECT ADDITIONAL OWNERS AGENT....-t?' i �.�lt�•_-_-__-_ BUILDING OR WORK - ...- - SEPTIC TANK,SEEP.PIT(S) ADDRESS...............-......_...__._.......----..--.._.._.._.._.._.._.._..__.._---..._. AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL Ej DRYWELL E] CA TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR REGULATING 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 ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AMT E LEGAL OWN- ER OF THE ABOVE ESCRIBED IDENTIA ROPERTY. BACKFILL SEPTIC TANKS SIGNATURE / SEEP.PIT(S)E] CESSPOOLS - ©� 2 OF PERMITTEE-__ 76A642A 663 7/ t