HomeMy Public PortalAbout9640 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 ENGINEER
I ADDRESS 1(9 b/!V f9"
FOR APPLI NT TO FILL IN LOCALITY
BUILDING NEAREST
ll
ADDRESS CROSS ST. �—
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST S
CROSS ST
RE�IVE BY � Ready for Inspection DATE ISS ED
OWNER /sem S
MAILUSE ZON OCCUPANCY BK
ADDRESS PG
CITY TELAO.
CONTRACTOR
CO.IMP.N0.
ADDRESS
JOB.NO. c
CITY N0. --
TRUNK PERMIT NO.
TE
REGISTRATION NO Z COURTY ROAD PERMIT N0. a`
LEGAL STATE ENCROACHMENT
0;
DESCRIPTION LOT N
L•' Z PERMIT N0. r
BLOCK ! TRACT V, e.2 G 0 INDUSTRIAL
WASTE APPROVAL,
SIZE OF LOT N0.OF BLDGS. CHARGES
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE E
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION R CORDED
WORK TO HOUSE SEWER 1.00
NO. DAT!S
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 I I IBY
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 I STATION ®♦ DEPTH
SPECIALCONDITIONS ONLY 2.00I MAN FERENC
yQ •3 UPPER E�
TYPE OF NECTION LENGTH FROM
OWNERS PERMIT $ I I ap ' CURB rg M.L.TO P L. �G
AUTHORIZATION I TOTAL FEE
IHAVE THIS
TO CONNECT THE ABOVE DESCRIBED ED APPROVALS
CONTRACTOR INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWERJ
SIGNED THIS.. &......_DAY OF -------- 192 NEW HOUSE SEWER G C'4
vv CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT_?. -. .. - R SEPTIC TANK,SEEP.PITS)
ADDRESS .. .-..F. .-.- �._- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL DRYWELL E]
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 E]
SIGNATURE SEEP PIT(S)E] CESSPOOLS En- gG a2 .5-�
OFPERMITTEE..--- � ------- - -•- ----- -......................
76A642D 663 1/53
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DEPARTMENT OF COUNTY ENGINEER 1, SEWER-SEWAGE DISPOSAL
DIVI9IOW_01F BUILDING AND SAFETY ; PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING I ADDRESS
OR APPLICA TO FILL IN LOCALITY
BUILDING r NEAREST
ADDRESS CROSS ST
LOCALITY DISTRICT NO V SERIAL NO. PERMIT NO.
� S
NEAREST I g /q 9�0 �� S
CROSS ST:
EC LVED QY Ready for Inspection' DATE ISSU D
OWNER
MAIL USE ZONE OCCUPANCY' BK MAP PO
ADDRESS
CITY TEL.N0.
CONTRACTOR CO.IMP.N0. Z S
ADDRESS/4�2)_ 5L�� �/�� )OB.NO.
Y//
CIT0, � TEL.N%. �f / TRUNK PERMIT NO. �+
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGALSTATE ENCROACHMENT
DESCRIPTION LO N0. A
/ PERMIT NO
BLOCK ! TRA C M1 /��� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOVC/X joeT
2 r NOW ON LOTS CHARGES
BUILDINGS�f,)y�
USE DCONNECTION CHARGE FEE
,
NO. DESMRIPTION OF WORK FEE
REIMBURSEMENT FEE -
HOUSE SEWER CONNECTING TO
PUBLICSEWER 3 3.50 RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OREXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 VO)
ALTER OR REPAIR EXISTING NOI DATE I 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 200 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
Y
OWNERS PERMIT $ I I 00 . CURB P.L. M.L TOP L.,
AUTHORIZATION I TOTAL FEE Od
NAED
CONTRACTOIR TO CONNECT THE ABOVE D SCRIBEDDATE CONTRACTED WITH THEIEXISTINGJ APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWE
•
SIGNED THIS---!J--._._DAY OF _.._ _._ 1 NEW HOUSE SEWER
�^ CONNECT ADDITIONAL
ONOWER OR BUILDING OR WORK S S"205-r=
WNERS AGENT ------ - - - ... - _..�._-....._. _
' / SEPTIC TANK,SEEP.PIT(S)
ADDRESS.........'_.---------------------------------_---.--------.._......_......._._.-- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-, CESSPOOL I-] 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 D CRIB D RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S) CESSPOOLS
OF PERMITT - ........-•--------------•--------------------
76A642A 663 7/53