HomeMy Public PortalAbout6152 AVON AVE_Sewer__ S BAE'8 3'1155 APPLICATION FOR PERMIT - 1
/DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engmeer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING -
LOCALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGAL OWNER
DESCRIPTION LOT N
MAIL
BLOCK TRACT O ADDRESS
NO OF BLDG$ CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS ¢ DISTRICT NO GROUP MAP PG
BK
M jv f
CONTRACTOR
CONNECTION DATA
ADDRESS 0
lsn 17
STATION DEPTH
CITY TEL �J( l
�,/ MANHOLE REFERENCE / UPPER
�'I ATE
REGISTRATION NO l ? 314 ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM d
PUBLIC SEWER @ $3 50 CURB P L M L TO P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
EXTN CESSPOOL DRYWELL MANHOLE Q $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO f
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO q
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OROWNERS AGENT, BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE COUNTY ENG EER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK m 0 CASH
3 6 0 3 °R AUG 6 1 A 4.5 0