HomeMy Public PortalAbout6117 AVON AVE_Sewer__ Sar8 31198 APPLICATION FOR PERMIT 1
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engmeer
County Of LOS Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY 4a r- ZZW
FOR APPLICANT TO FILL IN CROSS ST / a ri 6 ��
LEGAL 0 LOT / OWNER , 4
DESCRIPT NO
�/p MAIL
BLOCK TRACT ADDRESS
NO OF BLDGS CITY '
SIZE OF LOT NOW ON LOT C N Cf/CL. TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP
•�"� B K PG
CONTRACTOR /. d S70 L J_ M - /o/
ADDRESS ' CONNECTION DATA
i
�� STATION ® DEPTH
CIT wI r TEL NO /B MANHOLE REFERENCE UPPER
eb
REGISTRATION NO /�o5 '14 J C /�� ❑ COUT TY ® LOWER
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOYYPE OF CONNECTION LENGTH FROM p� /
PUBLIC SEWER @ $3 50 S O CURB P L M L TO P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO ! y JPNO
OB NO
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 /
PRIVATE HOUSE DIGWER CONNECTING TO
DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR / �ga, STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 ( O V PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT 8 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE -0
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER - NEW HOUSE SEWER
r
SIGNED THIS DA OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT le 6IJSEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLO 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
1HEREBY 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 OWN OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEEAe
15
JOHN A LAMBIE COUNTY (NEER VALIDATIO ROBERT A WOOD CHIEF PLBG INSPECTOR
CK M O CAS
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