HomeMy Public PortalAbout9632 LEMON AVE_Sewer__ ' 1 3;2-y _I
DEPAW04ENT OF COUNTY ENGINEER SEWER-SEWAGE DISP®SAL 1
DIVISION OF BUILDING AND SAFETY ! PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER I AUILDING
DDRESS
I
• FOR APPLICANT TO FILL IN LOCALITY
I
BUILDING NEAREST //
ADDRESS CROSS ST. 'jyl /t9 L� V 01
LOCALITY DISTRICT NO. SERIAL N6. PERMIT NO.
NEAREST �~ A Hyl 3 S
CROSS
RECEIVED Py Ready for Inspection DATE ISSUED
OWNER 041 [r? 15
USE ZONEOCCUPANCY
MAIL [[ MAP
ADDRESS I BK PG
CITY -A-- TEL.NO.p O �� A
CONTRACTOR fCO.IMP.NO. .�
ADDRESS ® • ' JOB NO.
CITY A.114, TE L.N • 0 � TRUNK PERMIT NO.
REGISTRATION NO Em STATE i ROAD PERMIT NO.
LEGAL QQ u
DESCRIPTION L NO. IV, STATE ENCROACHMENT
PERMIT NO
BLOCK ` TRACT INDUSTRIAL
SIZE GF LOT N0.OF BLDGS. WASTE APPROVAL
NOW ON LOT CHARG
USE OF
BUILDINGS "s CONNECTION CHARGE FEE
N0. IDESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE --
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.ORXCEPTION RECORD
WORK TO HOUSE SEWER 1.00 U�
ALTER OR REPAIR EXISTING 0. DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
- A D/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATIO DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 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 ;Ll 4,66
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 OF----------------_-__--______--. 19NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT---–------–------–-----.............................................---• . BUILDING OR WORK '(S
ADDRESS-----------------------_ SEPTIC TANK.SEEP.PIT(S)
– – – – –... – AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED ESIDENT AL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S)E] CESSPOOLS
OF PERMITTE –
76A642D 663 1/58
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELESI _
WILLIAM J. FOX, COUNTY ENGINEER LI BUILDING 0I ^8
ADDRESS s
FOR APPLICANT TO FILL IN LOCALITY To y)A @ 6
BUILDING �` NEAREST h
ADDRESS CROSS ST. ,
LOCALITY{. DISTRICT NO. SERIAL N(r PERMIT-NO.-
NEAREST
ERMITN0.NEAREST A 446 ,2 ;Z .4-OR7S
CROSS ST
RECEIVED Y Ready for Inspection DATE ISSUED
OWNER
MAIL , I f
'ADDRESS
USE ZONE OCCUyPANCY BK MAP PG
CITY TEL.NO. ID /� �r/� C
CONTRACTOR 7 I l 3 Pl^v
CO.IMP.N0. `J
ADDRESS s I
JOB N0.
CITY42-Alt
R T�EL.NO�./ TRUNK PERMIT N0.
REGISTRATION NO.// 3G�.� _ ' 7
L "r 4d ta ¢gam ROAD PERMIT NO. 3 3 4' 3L
LEGDESCRIPTION LOT NO. ��_� STATE ENCROACHMENT
y � PERMIT NO.
BLOCK TRACT , >� wLd�cV ` INDUSTRIAL z
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. i}
NOW,ON LOT Qs. CHARGES
USE OF
BUILDINGS CONNECTION CHARGE-FEE----_-- •
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO - REIMBURSEMENT FEE - —
PUBLICSEWER $ -3.5()- Sd RECEIPT NO. DATE- I"BY,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 ___
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECO RUED_ "
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING ` NO. I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/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 2.00MANHOLE REFERENCE ,,f
LOWER
TYPE OF CONNECTION• LENGTH FROM
OWNERS PERMIT $ 1 pp% CURB —_1216. M.L.TO P.L.
AUTHORIZATION TOTAL FEE so
I HAVE THIS DATE CONTRACTED WITH THE HEREIN 'NAMED
CONTRACTOR TO-CONNECT THE ABOVE DESCRIBED EXISTING' APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THEPUBLICSEWER�'
SIGNED THIS----1-R.41DAY OF------C�� NEW HOUSE SEWER � — -� 3
OWNER -OR, CONNECT ADDITIONAL ;
OWNERS AG NT o_'___- .. ` " ®--- BUILDING OR WORK
ADDRESS---- .- - -- -L'_- :- !_= EPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD_,.
I HEREBY ACKNOWLEDGE THAT I 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 PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS �}, IL
SEEP.PIT(S)� CESSPOOLS[A 7'
SIGNATURE
f ��® 1
OF PERMITTEE--reml9 - -------- -- - .. --•-- _ ..
76A642D 663 1/53