HomeMy Public PortalAbout6125 AVON AVE_Sewer__ CE808 111 137 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL—
DEPARTMENT OF COUNTY ENGINEER sm
1
BUILDING AND SAFETY DMSION BUILDINGL
ADDRESS G6__ - ~
JOHN A LAMBIE County Fa weer l
CASSATT D GRIFFIN Supt of Buildmg
LOCALITY +
FOR APPLICANT TO FILL IN
NEAREST
LEGAL -
DESCRIPTION LOT NO e2, OWNER
BLOCK TRACT s—17 0 '3 MAIL -
ADDRESS
NO OFBLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO ✓
USE OF
BUILDINGS DISTRICT NO I GROUP MAP
CONTRACTOR ` BK PG
ls9 ` / 0/
ADDRESS CONNECTION DATA
C TEL NO r STATION -h -A_ -Cl.. DEPTH
` COUNTY MANHOLE REFERENCE f� (`O LPPER
REGISTRATION NO/ V `1
no DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 50 40 v +
SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNE N LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y CURB4 P L M L TOP L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO 99 P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO J JOB NO
CONNECT ADDITIONAL BLDG OR ��11
WORK TO HOUSE SEWER @ $1 00 OV TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL m
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
t HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED-CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC EWER
SIGNED THI A OF g NEW HOUSE SEWER -
i(ir
OWNER OR - CONNECT ADDITIONAL-- - -
OWNERS AG BUILDING OR WORK
ADDRESS - - - SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 4ir
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑ y
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING '
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE_ ABANDON HOUSE SEWER
DESCRIBED RESID p OPE TY BACKFILL SEPTIC TANKS ❑
SIGNATURE //J SEEP PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE -
9pCALIDATION -; ROBERT A WOOD
cic la o CASH SUPERVISING MECHANICAL ENGINEER
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