HomeMy Public PortalAbout6145 AVON AVE_Sewer_1/21/1960_house sewer connection to public sewer d �
D
CE808 8 58 APPLICATION FOR PERMIT 1
B8O8
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE County Engineer ADDRESS
_
CASSATT D GRIFFIN Sup t of Building LOCALITY '
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL f
ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GRP MAP P CESSED
J� LL ��BK PG
CONTRACTOR /Of
ADDRESS CONNECTION DATA
CITY TEL NO STATION DEPTH
ATE MANHOLE REF EREN E UPPER
REG STRATTON O COUNTY i
No I DESCRIPTION OF WORK FEE ,
HOUSE SEWER CONNECTING TO 1z s
PUBLIC SEWER a $8 00
SEPTIC TANK SEEPAGE PIT OR I TYPE OF ION LENGTH FRO
PITS AND/OR DRAINFIELD @ $8 00 Y CURB P L M L TOP L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO /-3P No
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP 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 $1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERM $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I LS HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVADATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC
SIGNED THIS AY OF Ig NEW HOUSE SEWER
OWNER OR /f CONNECT ADDITIONAL
OWNERS AGENT ✓ ) BUILDING OR WORK
SEPTIC TANK SEEP PITS)
ADDRESS — AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LtGAII OWNER OF THE ABOVE
DESCRIBED RESIDE7 PROP 'fY BACKFILL Ste$
SIGNATURE CESSPOOLS 7',
OF PERMITTE
OMMATION ROBERT A WOOD�
M p 89 SUPERVISING MECHANICAL ENGINEER
5513 JAR21 1 0 A 50Q m ,