HomeMy Public PortalAbout6022 AVON AVE_Sewer_1/26/1966_house sewer connection to public sewer CE808 3 64
76A642D APPLICATION FOR PERMIT
A64
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
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL /
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT 9 ;1-Ix ADDRESS I
NO OF SLOGS — /
SIZE OF LOT NOW ON LOT CITY TEL NO 4
USE OF DISTRICT NO I GROUP MAP PROCESSED BY
BUILDINGS Af
BOK/� P G
CONTRACTOR '/ /V/
ADDRESS I/ J CONNECTION DATA
CITYEL NO ^3 STATION O +15 DEPTH
STATE MANHOLE REFERENCE iiAl�F!
REGISTRATION NO COUNTY -0 LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FR15m /
HOUSE SEWER CONNECTING TO Y CURB M L TOP L
PUBLIC SEWER @ E5 00
PC NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 0 $10 00 '68TIF 'pv�', JOB NO d
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O
PRIVATE DISPOSAL SYSTEM $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVIN 1A114INI RECORD INSTR NO DATE
WORK TO HOUSE SEWER $300 O
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ 6500 V
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING LU
CL
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT N
PERMIT NO Z
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 21 00 CHARGES
AUTHORIZATION I TOTAL FEE 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 ,{r 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT Y �,
CONNECT ADDITIONAL
ADDRESS QTJ-U"f BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
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 AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
LLR
IN THE ABOVE DESCRIBED RESID TIAL PROPE TY ABANDON HOUSE SEWER
RE BACKFILL SEPTIC TANKS ❑
MITTEE SEEP PIT(S) ❑ CESSPOOLS ❑
�{ALIDATION ROBERT A WOOD
SUPERVISING MECHANICAL ENGINEER
CK M O CASH
LACo 9 1 5 3 a JAN 2 6 1 0 A 7 00-