HomeMy Public PortalAbout9434 LEMON AVE_Sewer__ r ® ® p�.��qq PERMIT
gyp/4- �04q- .=4 /6`I Q/V 9
"{76A6420 AP LIGATION • 0 O 0 G..� RY�I9 ' 7 1
5 B E-663 12.54
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer 3M
County Of L08 Angeles ADDRESS a
BUILDING (y �^' �p yi,
WM. J. FOX, COUNTY ENGINEER `f 2,
CASSATT D. GRIFFIN, SuP'T OF BUILDING LOCALITY p e T
FOR APPLICANT TO FILL IN NEAREST,
CROSS ST. _ if
LEGAL Q J-37
- 7
DESCRIPTION ' LOT NO I / OWNER, kZ_BLOCK TRACT -�+ /p MAIL -
�aT42,l ! A,-),,, 1 l Q ADDRESS �r r b t9 de., hA
�/ NO. OF BLDGS.
SIZE OF LOT -r '�L• '� NOW ON LOT 1ft CITYTEL. NO ., d
USE OF
BUILDINGS �- DISTRICT NO. GROUP MAP
CONTRACTOR ® Lt-1 17 e - PG0
f,
ADDRESS 0 k „�,� �� a� CONNECTION DATA �.0f��
CITY 12 JX ei�5, TEL NO. &q_ ,� t�� _STATION V60 DEPTH
❑ STATE /' MANHOLE REFERENCE
REGISTRATION NO ❑ COUNTY �G/ �b LOWER
TYPE ECTION LENGTH FROM
NO, DESCRIPTION OF WORK FEE Y CURB P L. M L TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @- $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO, IMP. NO. e% � JOB NO.
WORK TO HOUSE SEWER 1 00 _
ALTER OR REPAIR EXISTING 065,2-
SEWER OR DISPOSAL SYSTEM 00 TRUNK PERMIT N0. ROAD PERMIT N0.
14
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL _
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE _
OWNERS PERMIT g 1 00
AUTHORIZATION TOTAL FEE — REIMBURSEMENT-FEE
I HAVE THIS-DATECONTRACTCD WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE,
TO THE "PUBLIC SEWER -
NEW HOUSE SEWER �. s � y
SIGNED THIS AY 19- _ _t2
OWNER OR �� �r• CONNECT ADDITIONAL
OWNERS AGENT -�� -"I- BUILDING OR WORK
` SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL❑
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 PLUG
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF D
DISCONNECT ABANDON HOUSE SEWER
AND
D
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
LSMIG
ESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS -7 '4
I\ tS�J
NATURE
SEEP. PIT(S)
❑ CESSP OLS
OF PERMITTEE• -� '� Q rr�Lp1 -
WILLIAM'J. FOX,COUNTY ENGINEERWIMATION
BY _ t + 4 2 9 9� 'JU1V 2 4 45 0 tn,
BY
DEPUTY DEPUTY
BY BY
® DEPUTY DTY