HomeMy Public PortalAbout9504 LEMON AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
` COUNTY OF LOS ANGELES
-i.. WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
' FSR APP • LOCALITY A TO FILL IN Li1/�/I-P
-BUILDINGJd� ,�,. 1 , NEAREST
.
ADDRESS ��-��lI��JJ/�W w CROSS ST, -
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST S A / civ /Z��J
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
• /""�1C/ / /T C�
ADDRESS �� USE ZONE OCCUPA Y MAP
BK PO
CITY EL.NO. fy�j .�7 f.Z 4,6 -.;. --
CONTRACTOR
0.IMP.N0.
ADORES
JOB.NO.
CITY TEL.NO. TRUNK PERMIT NO.STATE
'
REGISTRATION N0. :7 O/f COUNTY
ROAD PERMIT NO. (7
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT '/ INDUSTRIAL
+j ! WASTE APPROVAL
SIZE OF LOT /�j / � NOW ON LOTOF S
CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE -
HOUSE SEWER CONNECTING TO
PUBLICSEWER 0 $ 3.50 RECEIPT N0. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR- EXCEPTION RECORDED
WORK TO HOUSE SEWER - 1.00- 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/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
Urn SCJ LOWER
TYPE OF CONNECTION LENGTH FRO --
`x+ CURB --�P.t. M L.TO P.L.
OWNERS PERMIT 3 � i oo ,
AUTHORIZATION TOTAL FEE
HAVE THIS DATE CONTRACTED WITH THE -HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNAT RE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS---;'.`-.-.-_DAY _ __ _--iq•=y? NEW HOUSE SEWER
- - -- -
ell
- CONNECT ADDITIONAL
OWNER OR I ,10 BUILDING OR WORK
OWNERS AGENT------- - . ..... - -...--.-...
f SEPTIC TANK,SEEP.PIT(S)
ADDRESS.. .�Q-Y.. -------.- _. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- t CESSPOOL E:] DRYWELL E]CATION AND 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. t SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED-A REQUIRED BY LOS ANGELES COUNTY, DISCONNECT PLUG AND
AND STATE OF C 0 NIA OR THAT 1.,401THE EGAL ABANDON HOUSE SEWER
ER OF THE ABO ID IAL P PERT BACKFILL SEPTIC TANKS
SEEP.PIT(S)❑ CESSPOOLS E '
SIGNATURE
OF PERMITTEE - - -
i OA642D 663 1/53