HomeMy Public PortalAbout5941 AVON AVE_Sewer_4/26/1965_house sewer connection to public sewer 10-63
76A6420 APPLICATION FOR PERMIT
'
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building o von Ve o
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. Tesl i t; Dr
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL a er e VTr
p
BLOCK TRACT ADDRESS
F BLDGS. 5926 O O o BjvdO
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF Residence DISTRICT NO. GROUP MAP Y PROCESSED BY,
BUILDINGS
` CONTRACTOR
ADDRESS enry • Vega CONNECTION DATA !!!///CCCrrr
.O 1Kar V • STATION DEPTH
CITY SSG TEL. NO.
O 1ATE MANHOLE REFERENCE UPPER
REGISTRATIO ❑ COUNTYZ, �
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION - LENGTH FROM
HOUSE SEWER CONNECTING TO 0- �i Y. CURB .L. M.L.TO P.L. ..
PUBLIC SEWER @ $5.00
CL
SEPTIC TANK.SEEPAGE PIT OR P.C.NO. O
PITS AN.
/OR DRAINFIELD @ $10.00 CO.IMP. NO. .IOB NO.
V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ S3.00 ^
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAi V'" EASEMENT RECORD. INSTR.NO. DATE 0
WORK TO HOUSE SEWER @ $3.00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD W
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 d
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING N
SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT
9 I PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE '`" / .
'1 HAVE 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 OFOWNER OR Nezn>• NEW HOUSE SEWER ,/ e,
[WITH
NERS AGENT 1V
CONNECT ADDITIONAL f T
BUILDING OR WORK
RESS
SEPTIC TANK,SEEP,PITtS)
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ALL COUNTYORDINANCES AND STATE LAWS REGULATINGMBING AND SEWERS. CESSPOOL ❑ DRYWELLHEREBY CERTIF T K7�I AM PROPERLY REGISTER D AN��OR ALTER,REPAIR,SEWER OR
ENSED AS R - DBYLOS ANGLES COUNTY A STA21E OF SEWAGE DISPOSAL SYSTEM
IFORNIA O AT IAM THE LEGAL OWN. OF, D INTEND TO DISCONNECT PLUG AND
IDE IN, YE DESCRIBED REST E AL OPERT ABANDON HOUSE SEWER
F PERBACKFILL SEPTIC TANKSF PER
❑ CESSPOOLS ❑
VALIDATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
' C K. M.O(.'� CASH 1
0 n 7