HomeMy Public PortalAbout6141 AVON AVE_Sewer__ 1,
24650 INSERTS
CE808 6-60
APPLICATION FOR PERMIT
76A642D SEWER-SEWAGE DISPOSAL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, County Engineer
WILLL4M A. jENSEN, Supt of Btuldfng LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. 4 `
LEGAL �"w OWNER
DESCRIPTION LOT NO. r v(/
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS. G
SIZE OF LOT NOW 0 OT CITY TEL, NO
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
Y I P6 I
' CONTRALTO - �/� I r
ADDRESS C014NECTION DATA
CITY j L.N0: "' �,,� STATION DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO. �!f / COUNTY y` w -LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF NECN LENGTH FROMl')
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
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, y.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. V
WORK TO HOUSE SEWER @ $1.00
SEWER OR DISPOSAL SYSTIR OR DON EM HOUSE @ $1 00 STATE ENCROACHMENT ta
PERMIT N0. O
INDUSTRIAL U
WASTE APPROVAL W
•° CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION 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.
SIGNED THIS ABY OF 19_ 1 NEW HOUSE SEWER -t
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT / BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 4
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR = DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ij ABANDON HOUSE SEWER
CALIFORNIA OR T I AM THE LEGAL
/�/OOWWjNER OF THE ABOVE
DESCRIBED RESIDE IAL PROP' BACKFILL SEPTIC TANKS E]
SIGNATURE � SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTEE
OF VALIDATIN ROBERT A. WOOD
CK. M.0. J/���� SUPERVISING MECHANICAL ENGINEER
J , r
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