HomeMy Public PortalAbout9620 LEMON AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEINER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
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NEAREST
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LOCALITY C 4e C// DISTRICT NO. SERIAL NO.J/ PERMIT
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NEAREST '!L � A �! � 6 �,
CROSS ST. f
RECEIVED BY Ready for Inspection �DpATEpI�SSIJED _
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CITY ���,�� TEL.NO
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ADDRESS JOB.NO.
CITY TEL.NO. T 1 TRUNK PERMIT NO.
STATE
REGISTRATION N0. a COUNTY, ROAD PERMIT NO. / f,
LEGAL �J J
DESCRIPTION LOT NO. STATE ENCROACHMENT \ /
.AL/ PERMIT NO.
BLOCK TRACT 4,oW J INDUSTRIAL \ /
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. N
NOW ON LOT CHARGES /
USE OF � C �j/��
BUILDINGS (� C CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE ir
HOUSE SEWER CONNECTING TO W
PUBLICSEWER S 3.50 RECEIPT NO. ( DATE \ BY z
HOUSE SEWER CONNECTING TO
z
PRIVATE DISPOSAL SYSTEM 1.00 Z
CONNECT ADDITIONAL BLDG.OR EXCEPT19&RECORDED wWORK TO HOUSE SEWER - 1.00 -
ALTER OR REPAIR EXISTING NO- DATE BY y.
SEWER OR DISPOSAL SYSTEM 1.00 Z
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL.SYSTEM 1.00 CON ECTION DATA O
SEPTIC TANK,SEEPAGE PIT OR U
PITS AND/OR
DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL K
SPECIAL CONDITIONS ONLY 2.00 MINHOLE
UPPER REFERENCE LOWER 0
U.
TYPE OF CONNEC ON LENGTH FROM
Y. CURB P.L. M.L.TO P.L
OWNERS PERMIT $ I 1 Q() -i
AUTHORIZATION I TOTAL FEE - I Z' 1,•o : : _ w a
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THEkL. AY
WER
�� NEW HOUSE SEWER
SIGNED THIS----------- F___.._.. __. .......IT_-__.
CONNECT ADDITIONAL.
OWNER OR .. BUILDING OR WORK
OWNERS AGENT ------------------ -- x' 44
••S---
SEPTIC TANK.SEEP.PIT(S) -
ADDRESS- -----................. - ............... .............. •...------. AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL[:] DRYWELL
CA
TIONAND 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 PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
ANDOSTATE OF CALI ORNIA OR THAT 1 AM THE LEGAL OWN-
ER F THE ABOV SCR1 ED_ RESIDENTIAL PRPPERTY. BACKFILL SEPTIC TANKS
SIGNATUREG SEEP.PIT(S)� CESSPOOLS
OFPERMITTEE -------------------•----_----------------------•-.---_---------------
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