HomeMy Public PortalAbout6153 AVON AVE_Sewer__ D
S&E 689 I1 39
APPLICATION FOR PERMIT 1
5&E 8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engmeer
County of Los Angeles BUILDING S
JOHN A LAMBIE COUNTY ENGINEER ADDRESS ✓ go 0
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NCRO S ST c`N 4 6a" j
LEGAL
DESCRIPTION LOT NO 2S OWNER RI &r ( 4 c&E
MAIL
BLOCK TRACT �+ ADDRESS J tl Al
NO OF BLDGS
SIZE OF LOT Q 0 NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP
CONTRACTO `/� BK_ /0G/
ADDRESS 2_Z V jq t4 R CONNECTION DATA ,
V L`Q r STATION DEPTH
Z'ACITY TEL NO T J MANHOLE REFERENCE UPPER
LOWER
REGISTRATION NO , ' ❑ COUNTY /
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUY CURB PL ML TOPL
BLIC SEWER @ $350
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD I v P C NO
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 l O 'C) 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 12-10."1
1 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
r
OWNER OR BUILDING OR WORK
OWNERS AGENT 'Z I SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I 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 SEWEROR
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 1 AM THE LEGA OWNER OF THE ABOVE
DESCRIBED RESIDENTIA ROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) [I CESSPOOLS❑
OF PERMIT
JOHN A LAMBIE NTY EfNGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK N 0 CASH
[I.T05283- DEC 23 4 200 M