HomeMy Public PortalAbout9526 LEMON AVE_Sewer__ a .
' 5 a.E-6D
5 63 12.54
APPLICATI®I�I .�f=OR PERMIT 1
&E-6
DIVISION OF BUMDING AND SAFETY SEWER-SEWAGE ®0 S P®SA L
Department of County Engineer
r
County Of LOS AIIgeleB BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST:/ Zwry, _ 7 4
LEGAL
DESCRIPTION LOT N0. OWNER
BLOCK TRACT
5ig ' _137 MAIL
ADDRESS
SIZE OF USE OLOT Shy �O� NOWONLOTS O
CITY .�/�J�� /' TEL N �J �Q
F
BUILDINGS DISTRICT 7. GROUP MAP
PG
CONTRACTOR W�YL'�, I 7- 141BK /1
ADDRESS Cf � sya�/ / CONNECT--ION DATA
CITY TEL NO. _Q �� STATION 2-lf 1, DEPTH
f ❑ STATE MAyF FERENCE
REGISTRATION NO. ❑ COUNTY �(,O /UPPER +
TYPE QF�°P}L T{,NECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE Y U P.L. M.L.TO P L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
I
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO. IMP N0. JOB. NO.
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT N0.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OP. 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
CONNECTION CHARGE FEE
OWNERS pE�T s t oo _
AUTHORIZATION I TOTAL FEE ® REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE'ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE'
TO,THE PUBLIC SEWER _ --
i NEW HOUSE SEWER
SIGNED 7HI5 DAY OF }�r�p �` 19�C
OWNER OR _� -4 0!/d- �� CONNECT ADDITIONAL NT BUILDING OR WORK
OWNERS AG
^ -,-�- SEPTIC TANK. SEEP, PITS)
ADDRESS /t,, AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A PLICATION CESSPOOL❑ DRYWELL[3AND 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
I 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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P��TY.`�/!� BACKFILL SEPTIC TANKS❑
1\In` SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE -
WILLIAM J.FOX, COUNTY ONGINFER VALIDATION
"BY -..G QY 2 v 4 Ute'► FEB f 4 4.5,V
DEPUTY — DEPUTY
BY BY �-
® DEPUTY DEPUTY l