HomeMy Public PortalAbout6126 AVON AVE_Sewer__ D
CE4308 B 89 APPLICATION FOR PERMIT +
EBOB
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE County En eer ADDRESS
CASSATT D GRIFFIN Supt of Building LOCALITY
NEAREST Ip
FOR APPLICANT TO M
CRO" ST
LEGAL /
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL
ADDRESS
J NO OF BLDGS
SIZE OF LOT / NOW ON LOT CITY TEL NO
USE OF
BUILDINGS `~ DISTRICT NO GROUP MAP I PR SSED BY
CONTRACTOR ✓ I BK G /
ADDRESS �j=J' CONNECTIONDATA
CITY TEL NO STATION ,y a DEPTH
E MANHOLE REFERENCE UPPER
REGISTRATION NO COUNTY
No DESCRIPTION OF WORK FEE
HOUSES SEWER TOPUBLIC @ $3 00
TYPE OFCTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y URB P L M L TO P L
PITS AND/OR DRAINFIELD @ $$00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I 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 SEWER 1
SIGNED THIS DAY O 19_ NEW HOUSE SEWER Jf1
OWNER OR CONNECT ADDITIONAL P
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S) "
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ND STATE OF a,
CALIFORNIA OR THAT IeMT GA NE F THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESID BACKFILL
SEEPPIT SEPTIC
SIGNATURE [I CESSPOOLS [3
OF PER
94 n VALIDATION ROBERT A WOOD
( c�/ yi o Ggb SUPERVISING MECHANICAL ENGINEER
Uj 9 9 5 ��l�i ? 2 v A 6 }