HomeMy Public PortalAbout6110 AVON AVE_Sewer__ m
76AG42D APPLICATION ■ppO R PERMIT
7
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DIVISION OF BUrLDING AND SAFETY SEWER-SEWAGE DISPOSAL
I Deportment of County Engineer IBM
County of Los Angeles BUILDING / V0 R/
WM J FOX COUNTY ENGINEER ADDRESS { 77 /$
CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY 1
FOR APPLICANT TO FILL IN
NEAREST
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL Q
ADDRESS cry
NO OFBLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO I
USE OF
BUILDINGS DISTRICT NO GROUP BK MAP PG
7
CONTRACTOR
r �! XO/
ADDRESS eo® , ���E� CONNECTION DATA
CITY � TEL NO �ijPv>J STATION DEPTH
• STATE MANHOLE REFERENCE
REGISTRATION NOI ,`� ❑ COUNTY UPPER LOWER
TYPE OF CONNECTION LENGTH SROM
NO DESCRIPTION OF WORK FEE Y CURB P L M L TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING 10
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 0 0 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT g 11-00
AUTHORIZATION TOTAL FEE '00REIMBURSEMENT FEE
IHAVE MED CON
TRACTORTTO CONNECTHIS DATE THE AABOVE CTED WDESCR BED EXIITH THE STINGADWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS AND/ORSEPTIC
TANK DRAINFEIELDPIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM ,�-I3:� // ln .i£w .ter✓
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS[ISEEP PIT(S)
❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J FOX,COUNTY ENGINEER VALIDATION
BY 1Lo�''
BY
c GrT 1 3j 4 2 0 n to
'I, DEPUTY DEPUTY DEPUTY
!BY BY
® UI I DEPUTY DEPUTY
COUNTY OF LOS ANGELES / SAN GABRIEL VALLEY # 0500 ! SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS ( I 125 BALDWIN SE 0500 1005280001
BUILDING AND SAFETY / LAND DEVELOPMENT ' ARCADIA CA 91007
�i PHONE (626) 574 0941 EXT
ILEGAL ID ISEWER / SEPTIC SEWER BUILDING ADDRESS 1
ITR 5903 LT 49 UN 002 1EXiST OCC GRP 1 6110 AVON AV 1
I (BUGS NOW ON LOT SGAB CA 917752606
(ASSESSOR INFORMATION NUMBER ICCNNECTION TYPE NEAR-ST CROSS STREET
15386 009 043 (ORIGINATION THOM,IS PAGE 596 GRID G2 LOCALITY SAN GABRIEL Cl
I I�LENGTH ML TO PL STATION DEPTH I I I
ITENANT IIMA40LE REFERENCE UPPER/LOWER (ISSUED ON PROCESSED BY
1 105/26/ln I VG
I j,CGt-lTY IMPROVEMENT NUMBER 1— d 1
(OWNER TEL NO IPLFN CHECF NUMBER IFINAL ATEA FINAL BY CODE 1
IMALONE JAMES E MABEL E (626) 287 4389 IIJOP NUMBER I e 1
16110 AVON AV 1TRUNK PERMIT NUMBER 1_ 2 0
ISGAB 917752606 IROFD PFRMIT NUMBER 1DESCRIPTIO7 OF WORK
11AFFADAVIT NO IREPAIR EXIT ON SITE SEWER LINE 1
IWAIVER NO
1APPLICANT TEL NO 1EA,EMENT NO I
ILEADINGEDGE PLUMBING AND ROOTER (888) 525-3234 I I I
I IRECDRD INSTRUMENT NBR RECORD DATE ISPECIAL CONDITIONS 1
IHICHWAY/STREET WIDENING I
iST;TE ENCROACHMENT,BERMIT NUMBER I
ICONTRACTOR TEL NO I I FEES PAID 1APPROVALS DATE INSPECTOR SIGNATURE 1
___�I,EADINGEDGE PLIIhIDING AND ROOTER (888) 525-3234
114124 EL CASCO ST LIC NO IFEF"DESCRIPTION QUANTITY UOM AMOUNT INEW 4OUSE SEWER
ISYLMAR CA 91342 912858036 I I ! { r I I I
101 PERMIT ISSUANCE FEE 26 10 ICONILCT ADDITIONAL 1 1 1
15 ALT/REP HOUSE SEWER 1 00 EAC 26 50 IBUIIDING OR WORK I 1
(ARCHITECT OR ENGINEER TEL NO ,� TOTAL FEES 54 60 1 -1-1 I
I (SEPT:-C TANC SEEPAGE PITI I 1
LIC NO ( - 1AND/OR DRA-N FIELD I I
1DRYWELL
SEWER MAP BOOK PAGE 1 (ALTER REFLIR EWER OR
I SEWAGE DISI OSAL SYSTEM
I ` IDISCONNECT�kPLUG AND I VVV
I I 1ABANDON HOISE SEWER I 1 1
l ;
I I (BACKFILL S-PTIC TANKS
I 5 ISEEP PIT _ CESSPOOL
1GRAYWATER YSTEM I
t
IRELORT ID DPR266 ROUTE TO BSO500
I I I
)
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