HomeMy Public PortalAbout9618 LEMON AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION °
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER H ADDRESNG
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jAPPLIC T TO FILL IN LOCALITY
LOCALITY
ADD RBUILDE NG
4&� t1le�Cb� NEARLST
CROSS ST. --- 0
LOCALITY �� DISTRICT N0, SERIAL NO. PERMIT NO.
.�- A
NEAREST L� C, 3 S
CROSS ST. JVV6 A
!� RECEIVE Ready for Inspection DACE RUED}
OWNER Oh
MAIL ell,/ ....
ADDRESS USE ZONE OCCUUP/A IA�CY B MAP PGPG
Li
CITY �9 � � TELr.N0. �+ �
CONTRACTOR " �( CO.IMP.NO. 13
ADDRESS L y I��C"¢ !�"q. �)'
/� � JOB N0.
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CITY "/3_TEL.NO. C� � � �-�-•
[, TRUNK PERMIT NO.
STATREGISTRATION NO. ! g COUNTY' ROAD PERMIT-NO.lg_LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT _
`�'� � ',M, ` PERMIT NO.
BLOCK '!r+" TRACTS 4`-�� "`!dl eii Gc INDUSTRIAL _
WASTE APPROVAL
SIZE OF LOT I�r; e_4 Co NO OF SLOGS.
NOW ON
LOT CHARGESUSEOF
v
BUILDINGS �'� t�
4' CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE _
HOUSE SEWER CONNECTING TO K REIMBURSEMENT-FEE r epi'
1 PUBLICSEWER (� $ 3.50 s"$' RECEIPT NO. I DATEBY `"`mss-
H 1
OUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
ALTECONNECT ADDITIONAL BLDG.OR �1 EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 ¢s _
R OR REPAIR EXISTING - J - NO DATE ABY
SEWER OR DISPOSAL SYSTEM 1.00' .�C(t7
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 L CONNECTION DATAI�-'
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIEL'D 2.00 .STATION l � DEPTH j
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 )��., MANHOLE REFERENCE '-hyy
J UPPER I p _
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT - :$ 1 '00 'Y's` cuR6 -P.
OWNERS M.L.TO P.L. r �+
AUTHORIZATION 'TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH,THE,HEREIN NAMED f -a•'
CONTRACTOR TO CONNECT THE'ABOVE DESCRIBEW-EXISTING APPROVALS INSPECTOR'SSIGNATURE :DATE'
DWELLING TO THE PUBLIC SEWS&}.�f / '1I_
SIGNED THIS._ ...__DAY OF_._Int'.`.: __.�..19 NEW HDUSE SEWER L L P L27-0S_
�.
OWNER OR _ . - L ��� BUILDING OR WORKNECT _
�� / / (*
OWNERS AGENT - �- -- -- ---:_.---- -.._..__�-.-�---..._..... � J
y,�" SEPTIC TANK,/SEEP.PIT(S)
ADDRESS '_---`------ = -------------•---- ......... - -- AND/OR DRAINFIELD
HEREBY.ACKNOWLEDGE THAT I HAVE READ-THIS APPLI- CESSPOOL[Z] DRYWELL
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. SEWAGE,DISPOSAL SYSTEM y
' I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED-AS REQUIRED BY LOS -ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE`LEGAL OWN-
ER OF THE ABOVE E RIB D T AL ROP RTY. BACKFILL SEPTIC TANKS
SEEP PIT(S)� CESSPOOLS
SIGNATURE
OF PERMITTEE---- ------ - �__—
---.. ...........
76A6421) 663• 1/53
DEPA_RTI14[ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER I BUILDING
ADDRESS
r_ —
APP IC T L IN LOCALITY 0,4---f -'A ��t e,
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT 90. U SERIAL NO. (/ PERMIT NO. .I
NEAREST A � Q
CROSS ST.
//RECpE�IVED BY Ready for Inspection DATE ISSUED
OWNER "� _?
MAIL
ADDRESS 1 USE ZONE OCCUPANCYBK MAP PG
CITY TEL.NO.
CONTRACTOR v ` y
CO.IMP.NO.
ADDRESS
JOB NO.
CITY 0 TEL.NO. 31d TRUNK PERMIT NO.
STATE
REGISTRATION NO. (n OAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
00, PERMIT NO.
BLOCK / TRACT INDUSTRIAL /
WASTE APPROVAL I�
SIZE OF LOT ��p NO.BF BL
NOW ON LOT
_�_ CHARGES
USE OF \
BUILDINGS CONNECTION CHARGE FEE \"Jr
NO. , DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE \
PUBLIC SEWER @ $ 3.50 RECEIPT N0. `SDA\ I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED `
WORK TO HOUSE SEWER 1.00 d \.,��Y
ALTER OR REPAIR EXISTING NO- DATE \BY
SEWER OR DISPOSAL SYSTEM 1.00 r
DISCONNECT AND ABANDON SEWER
AHD/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE 100
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS___.._.___ ..DAY O ..._......_.__._!�__ __-__.._i9_.__ NEW HOUSE SEWER
OWNER OR 0 � CONNECT ADDITIONAL
WORK
OWNERS AGENT_:-... 1__. BUILDING OR WORK CJI_\OC�Q.at 6 `j J
----...... - -
ADDRESS-_-._-______-_-------__ SEPTIC TANK,SEEP.PIT(S)
-- -.... — - - -- - - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
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. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY D
ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S)C3 CESSPOOLS E]
OF PERMITTEE......- - - -------------------.---------------------------------•--
76A642D 663 1/53