HomeMy Public PortalAbout6162 AVON AVE_Sewer__ per/ d
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9115, APPLICATION
ATION F'OR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING '
JOHN A LAMBIE COUNTY ENGINEER ADDRESS /
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY `� ,Q
w
FOR APPLICANT TO FILL IN
NEAREST .-.�
LEGAL
DESCRIPTION LOT N0 _ ! OWNER ,/
MAIL r
BLOCK TRACT ADDRESS ~
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO GROUP MAP
JrBK PG
CONTRACTOR i �i - ( J r /O
ADDRESS Ly - P 411� 4... '�lef CONNECTION DATA
1 �
CITY TEL NO STATION Q/ DEPTH
MANHOLE REFERENCE /¢Cr UPPER
�, ✓ 9> STATE /J , ifiiMER
REGISTRATION NO ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM O 0
PUBLIC SEWER @ $3 50 �L Y CURB P L M L TO P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00 / u
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP N_0 10B NO
O
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO !/ a
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $100 PERMIT NO ti
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT $ t 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 5
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 l NEW HOUSE SEWER <-
SIGNED THIS AY OF 19 CONNECT ADDITIONAL r
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTICTANK 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 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) [I CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK m 0 CASH
t,�Co 5 6 5 2- MAY 2 4 4 50 u)
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