HomeMy Public PortalAbout6120 AVON AVE_Sewer__ 6D
S&E89 11 S5
APPLICATION FOR PERMIT
8 @ E 8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deparbnent of County Engmeer
County Of LOS Angeles BUILDINFADRESSG Chi QJOHN A LAMBIE COUNTY ENGINEERCASSATT D GRIFFIN SUP T OF BUILDING CALITY 42
FOR ICANT TO FILL IN NEAREST
LEGALOWNER /� Q
DESCRIPTIO "LOT
BLOCK TRACT MAIL
S ®� ADDRESS 4"
�
NO OBLCITY TEL NO
SIZE OF LOT NOW-OO N LOTT
USE OF DISTRICT NO GROUP I MAP
BUILD G .CSG+' BK PG
CO CTO �.�. 31� /�
ADDRESS ` CONNECTION DATAr SCA �•+
STATION DEPTH
CITY / A L NO �`
MANHOLE REFERENCE UPPER
STATE
REGISTRATION NOF ❑ COUNTY
NO DESCRIPTION OF WORK FEE r
HOUSE SEWER CONNECTING TO TYPE OF CTION LENGTH FROM ,.+ r
Y C R PL ML TOPL 0
PUBLIC SEWER @ $3 50 —
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO �`jy JOB NNO
O
EXTN CESSPOOL DRYWELL MANHOLE Q $2 00
HOUSE SEWER CONNECTING TO /�1
PRIVATE DISPOSAL SYSTEM Q $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
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 ` -3-
,-% NEW HOUSE SEWER G�
SIGNED THIS 1,(,tv R 19CONNECT ADDITIONAL
OWNER OR _BUILDING D WORK
OWNERS AGENT SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 SEWEROR
PLUMBING AND SEWERS / SEWAGE DISPOSAL SYSTEM
I HEREBY C RTIFY THAT I AM PRO RLI REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED A OUIRED BY LOS ANG LES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNI R TH T 1 AM THE L GAL OWNER OFTH7,-)ABO EDESCRIB ESIDEN ]AL PROPERTY BACKFILLS '`SIGNAT "CESSPOOLS
OF PER LTTE
JOHN A LAMBIE OUNTY ENGINEER VALIDATIOb ROBERT A WOOD CHIEF PLBG INSPECTOR
CK II 0 ASH -
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