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Home My Public Portal About6166 AVON AVE_Sewer__ 6D S&E89 11 85 APPLICATION FOR PERMIT S& 6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A LAMB COUNTY ENGINEER ADDRESS ® CASSATT AL GRIFFIN SUP T OF BUILDING LOCALITY mm FOR APPLICANT TO FILL IN CROSS ST LEGAL ��` , DESCRIPTION LOT NO^J`/y OWNER �s-�y MAIL BLOCK TRACT, ^ / fel ADDRESSVJGN�O OF BLT CITY TEL20 -] SIZE OF LOT NOW ON LOT USE OF BUILDINGS DISTRICT NO GROUP MAP BK PG/ CONTRACTOR L tZ M ADDRESS r� 's CONMCTION DATA s CITY TEL NO r ,p STATION DEPTH b l MANHOLE REFERENCE O UPPER -STATE O REGISTRATION NO S I ❑ COUNTY _ NO DESCRIPTION OF WORK FEE 19 TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $3 50 c HOUSE SEWER CONNECTING TO '' Y CURB P L M L TO P L SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 7 OVERFLOW SEEPAGE PIT DRAINFIELD JOB C NO NO EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 CO IMP NO1,730 G� HOUSE SEWER CONNECTING TO qq�• PRIVATE DISPOSAL SYSTEM (�Ja $7 00 TRUNK PERMIT NO ROAD PERMIT NO141119 41-101,® CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER S PERWT S 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT 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 THI DAY 0 19 CONNECT ADDITIONAL OWNER ORBUILDING OR WORK OWNERS AGENT SEPTICYTANK 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 WITHALL 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 HE LEGAL OWN R OF THE ABOVE DESCRIBED RESIDENTIAL PRO RTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PIT(S) ❑ CESSPOOL E3 OF PERMITTEE i JOHN A LAMBIE CouNvKy ENGINEER �(ALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR CASH 6 0 7 ?u P1PY 16 A 450 IL06p74- 16 5 1000610 6&E 6D APPLICATION FOR PERMIT S&E 889 11 SS /'1 V �l DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of LOS Angeles BUILDING f JOHN A LAMBIE COUNTY ENGINEER ADDRESS r��,�,f (J 0 1V ® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY e �/p Ci�✓ FOR APPLICANT TO FILL IN cCRO sT f k,cC(e ti LEGAL OWNER If 09 Lt/QL DESCRIPTION LOT NO MAIL BLOCK TRACT ADDRESS 1 U V Aj NO OF BLDGS SIZE OF LOT NOW ON LOT CITY �� TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP BK PG CONTRACTOR CONNECTION DATA ADDRESS Z 7T' w /7 /'V Ji<�•T /` �l STATION DEPTH CITY �bA, TEL NO ^ MANHOLE REFERENCE UPPER REGISTRATION NO 1�� /l � COUNTY �� 1 / �J -z LOWER NO DESCRIPTION OF WORK FEE 6�- `a---��/ � HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM Y CURB P L M L TO P L PUBLIC SEWER @ $3 50 SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD P C NO EXTN CESSPOOL DRYWELL MANHOLE Q $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 Q $100 0 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL - SEWER OR DISPOSAL SYSTEM Q $100 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER S PERMIT $ 1 Oo REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE 1— 16 RI HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE TACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL r i OWNER OR �r Q� BUILDING OR WORK ' OWNERS AGENT /� SEPTICTANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT/ 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 1 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 P RTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑ OF PERMITTEE JOHN A LAMBIE CO Y ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR CK m 0 CASH a 09'2V $ d 200 r WORKERS' COMPENSATION DECLARATION 1 hereby.affirm that I have•a certificate of consent to self 76A642 DPW 6/89 Insurl�, or a certlfleate of Wbrkers' Compensation Insurance, or 76A842D FAL�rYr ` copy J,/��`�mcc 3800,J b ' APPLICATION FOR PERMIT ❑61/�ertiffied copy is heherecfby furnished pony - AK-<- SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department Date Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESS ! 0 STATION DEPTH (This section need not be completed If the work involved by theLOCALITY LOWER G MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) I NEAREST TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this CROSS ST. Y CURB P L M L TO P L permit is issued, I shall not employ any person in any manner LEGAL PC NO so as to become subject to the WOrk s' Co pensation La s. DESCRIPTION LOT NO. CO IMP NO JOB NO Date _2"JYApplicant BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO Tr ASSESSOR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE NOTICE TO APPLICANT If, after making this Certificate of MAPBOOK PAGE PARCEL Exemption, you should become subject to the Workers' No.OFBLDGS. Compensation provisions of the Labor code, you must forthwith SIZE OF LOT NOW ON LOT HWY OR ST WIDENING comply with such provisions or this permit shall be deemed USE OF revoked. BUILDINGS G- 7 STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATIONPFRMIT NO I hereby affirm that I am licensed under provisions of Chapter OWNER e �. Of 9 (commencing with Section 7000) of Division 3 of the Busi- MAIL44/04/ CHARGES ness and Professions Code, and my' license is in full force and ADDRESS (j effect. /nA• , CITY TEL NO "" Z3 ! CONNECTION CHARGE FEE License Numbe Lic. Class L' ZG REIMBURSEMENT FEE //// �/� /��,� G / CONTRACTOR�/��U�"� DISTRICT NO GROUP MAP PROCESSED BY ContractorU��/y��G-.7f'lLDote � �yY� ` y ADDRESS Alav L BK PG ❑ I am exempt under Sec. of the L.A.Co. CITY TEL N0 6 3 �'0" � 0 cLiQ EL Plumbing Code and/or Sec. of the STATE uc FI E d LICENSE NO. CLAS' "ZG_�4 VALIDATION Z B. 8 P Code for the following reason NO. 1 DESCRIPTION OF WORK FEE O HOUSE SEWER CONNECTING TO FINAL Date PUBLIC SEWER BY O SEPTIC TANK SEEPAGE PIT OR W a Signature PITS AND OR DRAINFIELD � OWNER-BUILDER DECLARATION HOUSE SEWER c ro , Z PRIVATE DISPOSALL SYSTEME I hereby affirm that I am exempt from the Contractor's License CONNECT ADDITIONAL BLDG OR Law for the following reason (Secton 7031.5, Buisness and Pro- WORK TO HOUSE SEWER fessions Code)' OVERFLOW SEEPAGE PIT DRAWFIELD ExTN CESSPOOL DRYWELL MANHOLE F, ❑ I, as owner of the property, or my employees with wages as ALTER REPAIR OR ABANDON HOUSE s✓1) (J C� their sole compensation, will do the work and the structure SEWER OR DISPOSAL SYSTEM _,2 is not intended or offered for sale (Section 7044, Business and Professions Code). ❑ I, as owner of the property, am exclusively contracting with OWNER'S Permit $ jti' s licensed contractors to construct the project (Section 7044, Business and Professions Code). AUTHORIZATION I TOTAL FEE ' CONSTRUCTION LENDING AGENCY i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACT R Tp ► I hereby affirm that there is a construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER for the performance of the work for which this permit Is Issued (Sec. 3097, Civ. C.). SIGNED THIS DAY OF 19_ OWNER OR Lender's Name OWNERS AGENT Lender's Address ADDRESS I certify that I have read this application and state that the above information is correct agree to comply with all County ordinances and State I s gulati Plumbing and Sewers, and hereby out riz .-rept septa of this County to enter upon the ob ti one pro for inspection purposes. Sign ture of Per tree Date SEE REVERSE FOR EXPLANATORY LANGUAGE