HomeMy Public PortalAbout9462 LEMON AVE_Sewer__ f
76A642 -6, APPLICATION FOR PERMIT
78A842D �+ r+
COUNTY of Los ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS ' O 1J
WILLIAM A. JENSEN, Sup't of Building LOCALITY E
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. VF
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LEGAL 7 OWNER
DESCRIPTION LOT N0. av
BLOCK TRACT HAIL
ADDRESS
Ji O.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF 7,
BUILDINGS L DISTRICT NO. GRO MAP PROCESS Y
�l BK! P3
CONTRACTOR Alert Plumbing & -Heatin j�zz� /vJ
ADDRESS 13933 So. Crenshaw Blvd. co cTI N DATA
CITY Hawthorne TEL.NO. OS 93691 STATION DEPTH
193617 C-36 5G S�� STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. COUNTY LOVER
NO. I DESCRIPTION OF WORK FEE c
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $9.00TY-Pt OFcCONNECT N LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD S3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN CESSPOOL DRYWELL @ S2.00
HOUSE SEWER CONNECTING TO P.C. 0. O
PRIVATE DISPOSAL SYSTEM @ S1.00 CO NO. JOB N0. U
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. w
WORK TO HOUSE SEWER 00
A LTER OR PAIR OR
R A ABANDON HOUSE @ $1,00 STATE ENCROACHMENT 0
PERMIT NO W
INDUSTRIAL (.
WASTE APPROVAL V)
CHARGES ?
OWNERS PERF S 2100 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
DATE A CONTRACT WITH THE HEEIN NAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIST NG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OR 19— NEW HOUSE SEWEROWNER OR VI t
OWN
ERS AGENT BUIJLDING 0NECT 8 WORKAL 1 1 Y7 I�
ADDRESS
SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 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 pLTER.REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTIAL PROPE Y. SEEP.PIT S ❑ CESSPOOLS
SIGNATURE
OF PERMITTE
VALIDATION ROBERT A. WOOD
CK.
9.0. CABN SUPERVISING MECHANICAL ENGINEER
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