HomeMy Public PortalAbout6132 AVON AVE_Sewer__ CEBOB 3 62
76A642D APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING / `7 L�
JOHN A LAMBIE COUNTY ENGINEER ADDRESS /
COLEMAN W JENKINS SUP T OF BUILDING
LOCALITYNEARE
CROSSST
FOR APPLICA T TO FILL IN
LEGAL
DESCRIPTION LOT NO O'D
MAIL
BLOCK TRACT L-` ADDRESS
5-9
NO OF BLDGS
-�7"'l
SIZE OF LOT NOW ON LOT CITY //=/�� L / ^/fEL
USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
I / ,� -L1�// Z I BK PG
CONTRACTOR L�`,., /t� LC TL- 1��G gay d / Q
ADDRESS p� S�Gziv CO CTION DATA l
CITY ATE /�C .� TEL NO ~ /��� STATION J o DEPTH
LIr
LICENSE NO �f'YJ�� ...0 C ASS / MANHOLE REFERENCE
V LOWER
NO DESCRIPTION OF WORK FEE TYPE OF TION LENGTH M
HOUSE SEWER CONNECTING TO �") Y CURB P L M L TOPF Q d
PUBLIC SEWER @ SS 00 T��
SEPTIC TANK SEEPAGE PIT OR 0 P C NO O
PITS AND/OR DRAINFIELD @ $1000
CO IMP NO 3 V SOB NO ,(' V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO `f//_
PRIVATE DISPOSAL SYSTEM @ 83 00 <�� O
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER I EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300 V
OVERFLOW SEEPAGE PIT DRAINFIELD W
EXTN CESSPOOL DRYWELL MANHOLE @ E5 00 d
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N
SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT S z}}} 00 CHARGES
7
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE A.QCN APPROVALS DATE INSPEC'LOiSSIGNATURE
SIGNED THIS DAY OF ! ����
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
CE /
LINSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND VV
RESIDE IN THE A;7�ESCRIBEDZZRESIDENTIAL` PROPERTY ABANDON HOUSE SEWER Y
SIGNATURE BACKFILLSEPTIC TANKS SEEP PIT S) ❑ CESSPOOLS ❑
VALIDATION JACK R ALLEN
CK M o CASH SUPERVISING MECHANICAL ENGINEER
I Ar, 3 -9 8 2- MAR 6 1 U D 7 00-
Y