HomeMy Public PortalAbout9660 LEMON AVE_Sewer__ CE808 10- 2
7GA642D e APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAM LE. County Engineer ADDRESS 9660 E. Lemon
WILLIAM A. JENSEN, Supt of Builduag
LOCALITY
NEAREST
FOR APPLICANT TO FIL9L'LEGAL IN CRDSS 5T T p
DESCR PTION LOT NO 310/� 1 p �� �J . C. Ashley
OWNER
( MAIL
BLOCK TRACT. �� ADDRESS
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITY CovinaTEL NO
USE OF D
BUILDINGS Res• DISTRICT NO GROUP MAP PROCESSED BY
BKPG�jf
CONTRACTOR pwpr 6_"_d<l<
ADDREss2933 Maxson Rd . CONNECTION DATA //f (/rte
CITY F-LMontTEL NO STATION DEPTH
Gl
STATE MANHOLE REFERENCE
REGISTRATION NO12A8 ElCOUNTY
RK FEE LOWER d
NO DESCRIPTION OF W TYPE OF CO 'CION LENGTH FROM O
1 HOUSE SEWER SEWER CONNECTING TO $5 00 00 Y CURB P L M L TO P L PUBLICU
PC NO
SEPTIC TANK,SEEPAGE PIT OR CO IMP NO JOB NO O
PITS AND/OR DRAINFIELD $10 00 O�O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT
PRIVATE DISPOSAL SYSTEM Q S300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT *
AIVER EASEMENT RECORD INSTR NO DATE d
WORK TO HOUSE SEWER @ $300
N
OVERFLOW SEEPAGE PIT,DRAINFIELD Z
EXTN CESSPOOL,DRYW ELL MANHOLE @ $5 00
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 21 Oo CHARGES
AUTHORIZATION TOTAL FEE 00 CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER r
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY A D STATE OF SEWAGE DISPOSAL SYSTEM
LRI"
ALIFORNIA OR THAT i AM THE LEGAL OWNER OF, D INTEND TO DISCONNECT PLUG AND
SIDE IN, THE ABOVEDESCRIBED RESIDENTIAL P PERTABANDON HOUSE SEWER
GNATURE (y BACKFILL SEPTIC TANKS ❑
OF PERMITTE "� SEEP,PIT(S) ❑ CESSPOOLS ❑
ALIDATION ROBERT A. WOOD CASH
SUPERVISING MECHANICAL ENGINEER
CK
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