HomeMy Public PortalAbout9437 LEMON AVE_Sewer__ �tF_Fr ��gvrr ON
S&E-688 3-58 `743
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APPLICATION FOR PERMIT _
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL.
Depax ent of County Engineer /I
County of Los Angeles IIUILD114G 9437 �t.P_rrtoat l3 v�
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY �p i
FOR APPLICANT TO FILL IN NEAREST
LEGAL
CROSS T.D
DESCRIPTION L07 NO. ` GY• 7 �e Q �� tie OWNER
BLOCK TRACT 54,0-4 A AJ r 7 A A M AWD (tea MAIL p,
OS J �ry�a n ADDRESS 7 y�� �eyKBM �-yQ-
_SIZE OF LOT 9�,5 X 3a® NOW ON LOT CITY Q � t TEL NO
USE OF
BUILDINGS ,LD30 rn I 1,.e�'�"� R DISTRICT NO. GROUP MAP
^ SK PG
CONTRACTOR o �� Af S M 2 C7
ADDRESS CONNECTION DATA
CITY NO! STATION DEPTH
E3STATE MANHOLE REFERENCE UPPER
REGISTRATION/NO. ❑ COUNTY �! LOWER
NO DESCRIPTION OF WORK FEE Add +o :4-- 4-2-6(oq
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $ 3 50 CURB P L M L TO P L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 _
CONNECT ADDITIONAL BLDG. OR Ud P C NO
WORK TO HOUSE SEWER 1 00 �� CO IMP. NO. JOB
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT N0. ,ROAD PERMIT NO.
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
pEI3M�, CONNECT; N CHARGE FEE
OWNER'S $ 1 00
AUTHORIZATION TOTAL FEE oo REIM URSEMENT FEE
TRACTORHAVE TTOS CONNECTDATE ONTRTHEAABODVEWDESCR BED EXIISTINGADWELLITH THE HEREIN MED CON-NG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER-
SIGNED THIS OF �Ql� Ig ,S'� NEW HOUSE SEWER
GW*eS
RCONNECT ADDITIONAL
OWNERS Z"oBUILDING i
sem
SEPTIC TANK, SEEP, PIT(S)
ADDRESS 24i 41
¢
AND/OR DRAINFIELD
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
PLUMBING AND SEWERS. ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGIST AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY D STATE OF DISCONNECT PLUG AND T
CALIFORNIA OR THAT I AM THE LEGAL 0 OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY, j BACKFILL SEPTIC TANKS❑
, SEEP. PlT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE ' -
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF FLOG. INSPECTOR
(096 9 1 o 4 4 2-00