HomeMy Public PortalAbout9534 LEMON AVE_Sewer__ 7BA6420
E-669 11.5 APPLICATION FOR PERMIT 1
8&6.88 '
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer _ n
County of Los Angeles BUILDI SG �� 3- I—En9 OWADDRE
JOHN A. LAMBIE. COUNTY ENGINEER
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLI�CrAN TQ FILL IN CROSS ST. '� �. Iy D
LEGAL �-
DESCRIPTION LOT NO OWNERf
BLOCK TRAM MAIL
ADDRESS
N0. OF BLDGS. ` CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF L"�J DISTRICT NO. MAP
BK PG
CONTRACTOR --T
pi
ADDRESS ��Q '�`�r�-J(f,�' /Th 5/ ._ • CONNECTION DATA
CITY TEL. NO. ��-lV� - STATION DEPTH '
r /� MANHOLE REFERENCE _ UPPER
REGISTRATION NO -71'7 `�C_ L�L�--C-6 TCNTY'- / - LOWER
No. DESCRIPTION OF WORK FEE
TYPE F CONNECTION - LENGTH FROM -
HOUSE SEWER CONNECTING TO Y. CURB P L M.L TO P.L.
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD - P. C. NO.,
EXTN ,CESSPOOL,DRYWELL,MAN HOLE Q $2 00 CO. IMP NO JOB O"
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT N0. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR _ //••��O STATE ENCROACHMEN
WORKJO HOUSE SEWER Q ,90 t/ PERMIT N0. '
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL ', O
SEWER OR DISPOSAL SYSTEM Q $1 00 _ WASTE APPROVA
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT S 1 00
O 6- REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY4fl- 19 CONNECT ADDITIONAL
OWNER OR � BUILDING OR WORK
/ -a
OWNERS AGENT / 1/�/
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNT AHD ST T.E OF ABANDON HOUSE SEWER
CALIFORNIA OR.r AT I AM TH LEG6L OWN OF T ABOVE
DESCRIBED RESIDEN IAL.P 120 BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PITS) ❑ CESSPOOLS❑
OF PERMITTEES
JOHN A LAiB , COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR
11 O CASH
5 2.1 2 SIP 25 1 A 4.0 0 M