HomeMy Public PortalAbout9516 LEMON AVE_Sewer__ 78A8
.66
BAPPLICATION FOR PERMIT 1
��aeDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer C
County of Los Angeles BUILDING V f �'
JOHN•A..LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST T.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT 7 ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT / CITY TEL N0. f� 7
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR �" '! 6' Z7 G,
ADDRESS .y .� CONNECTION DATA
y STATION DEPTH
CITY /� TEL. NO. �/ MANHOLE REFERENCE
/STATE f LOWER
REGISTRATION NO. :O ! ❑ COUNTY
NO. DESCRIPT ON OF WORK FEE '
TYPE OF CO CTION LENGTH FROM
PUBLIC SEWER @ $3 50 s _
HOUSE SEWER CONNECTING TO 1 . y_ RB j P L. M L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT. DRAINFIELD P C. NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO `��
PRIVATE DISPOSAL SYSTEM Q $100 TRUNK PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE '
OWNERS. PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �4
TO THE PUBLIC SEWER NEW HOUSE SEWER ,2 "
SIGNED THIS DAY F 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY AC N WLEDGE 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 ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF D
ABANDON HOUSE SEW
CALIFORNIA OR THAT I THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL PERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ElCESSPOOL
OF PERMITTE r
JOHN A. LAMBIEff,.9ffuNTY ENGINEER VALIDATION ROBERT,A WOOD, CHIEF PLBG INSPECTOR
/CR) N O CASH •
LACO
2 5,5 99`' SEP 23 4 450 M