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HomeMy Public PortalAbout9448 LEMON AVE_Sewer__ Em0e-D CE608.6-SB'' APPLICATIONS: FOR. PERMIT = _ COUNTY OF LOS ANGELES '.SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER ' BUILDING AND SAFETY DMSION BUILDING 'ADDRESS JOHN A. LAMBIE, County Fmgiaear ' CASSATT D. GRIFFIN, Supt of Builmg LOCALITY NEAREST FOR APPLICANT TO FII.L IN 'CROSS ST. LEGAL DESCRIPTION LOT NO. \ OWNER BLOCK TRACT MAIL ADDRESS + / y NO.OF BLDGS. - " SIZE OF LOT �£v C!5 /� NOW ON LOT CITY `NO. USE OF, BUILDINGS DISTRICT NO. GROUP AP PROCESSED BY CONTRACTOR LI B K PG ADDRESS — CONNECTION DATA CITY SEL 0. �� STATION DEPTH TATE MANHOLE'REFERENCE UPPER REGISTRATION NO. COUNTY NO.' DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 $3.00 TYPE OFC ON LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. URB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD , EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TOP.C.NO, PRIVATE DISPOSAL SYSTEM Q $1.00 CO.IMP.NO. - JOB NO. CONNECT ADDITIONAL BLDG.OR 00 TRUNK'PERMIT f(0. _ ROAD PERMIT NO. WORK HOUSE SEWER @ $1.00 ALTER,REPAIR OR ABANDON HOUSE STATE ENCROA N SEWER OR DISPOSAL SYSTEM 0 $1.00 PERMIT NO. ` INDUSTRIAL WASTE APPROVAL ' ' CHARGES OWNERS PERMIT S 2 -00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVAIs DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS SAY OF 19_ NEW HOUSE SEWER - OWNER ORn CONNECT ADDITIONAL OWNERS AGENT ✓ '"� � BUILDING OR WORK - 1(! v' SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I 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 ALTER,REPAIR, SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM L� 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 WNER OF THE ABOVE DESCRIBED RESIDEN PROPER - BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP. PIT(S) CESSPOOLS O J OF PERMITTE ®� r-` ALIDATION ROBERT A.WOOD C6. M.Or C/{gg SUPERYISIN6 MECHANICAL ENGINEER ?� LAr" �, 1. 7'8 u► b 2d 1 © A 6.0,0 Try 2