HomeMy Public PortalAbout9624 LEMON AVE_Sewer__ DEPAliTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS
FOR APPLICANT /1�! _4_TO,FILL IN � _LOCALITY �
ADDRESS y( 9 ��= �' E��� NEAREST �� ^ /J
CROSS ST. �(
LOCALITY , IS(`q. DISoT,RICT NO. U SERIAL NO. / PERMIT NO.
NEAREST.-IF 'J ' VA
RECEIVED BY Ready for Inepeetlon DATE ISSUED
OWNERS
J ` A
MAIL r
9 USE ZONE OCCUPANCY MAP
ADDRESS / �/ o
BK PG
CITY &ael d TEL.NO.
CONTRACTOR
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CO.IMP.NO.
ADDRESS Aq> i
�� �&O JOB N0.
CITY rTELAO. - . �J� � TRUNK PERMIT NO.
REGISTRATION NO. ��� COUNTY t(
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. -4 STATE ENCROACHMENT s.
PERMIT NO.
BLOCK TRACT �� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT y NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF ��y ��[ ����,�°
BUILDINGS C� CONNECTION CHARGE FEE
NO. -DESCRIPTION OF WOFlfK FEE ----
HOUSE SEWER CONNECTING TOREIMBURSEMENT FEE
PUBLIC SEWER ,d $ 3.50 ' RECEIPT NO. _j___--DATEI BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO H_OUSE SEWER 1.00
ALTER OR REPAIR EXISTING ` NO TE " -BY
j
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR -
PITSAND/ORDRAINFIELD 2.00 STATION J�7L- 1 --DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 'y M}�NHOLE_REFERENCE
-Z L+/ . iia- ZE41"' 0/_ LOWER
� YOE OF CONNECTION , LENGTH FROM
OWNERS PERMIT $ I 00_1 CURB `P -+ M L.TOP L
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED,
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING -APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.....;".........DAY OF__.._.-..�^-�Lc_ 19� NEW HOUSE'
SEWER 1 2y_6
OWNER OR p a• _ t CONNECT ADDITIONAL
OWNERS AGE
ppNT L �/`!`�..__yy,_.4.-"!✓'. _ BUILDING OR WORK
f_K ___..: __-__f`a;'! ls
ADDRESS._- ._.W _...__ 'SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT-1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL
CAT
IONAND 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
AND STATE OF CALIFORNIA OR THAT I AM TH .LEGAL OWN-
ER OF THE ABOVE D CRbBED RE IDENTIAL'" ROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE A ► �- _ SEEP.PIT(S)� CESSPOOLS ;
OF PERMITTEE-----------
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