HomeMy Public PortalAbout6215 AVON AVE_Sewer__ " DEPARTDIENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL our-
DIVISION
urDIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER BUILDING
ADDRESS o7
FOR APPLICANT TO FILL IN LOCALITY
BUILDADDREING SS �j ��� ����J/� NEAREST
CROSS ST
LOCALITY ''—�Ci DISTRICT NO SERIAL NO PERM T NO c
NEAREST l / A ��� D 6 J
CROSS ST S (JF GOiI//-�fN
RECEVED BY Ready for Inspection DATE ISSUED
OWNER r�/� ^//�/�J f7 T) I USE ZO E OCC NCY /P�
MAIL
ADDRESS
CITY TEL NO
CONTRACTOR �3«�S c v t�d/{�S l'
' CO IMP NO
ADDRESS r } JOB NO
CITY EL NO L4 A-41 ,Q TRUNK PERMIT NO
STATE d
REGISTRATION NO ® COUNTY ROAD PERMIT NO
LEGAL ^
DESCRIPTION LOT NO Z (o STATE ENCROACHMNTPERMIT NO
BLOCK TRACT �j d JJ t
WASTEDUSTRI AL
PROVAL
SIZE OF LOT ( Z Z NO OF NOW ON LOTS Z_ CHARGES
USOF
BUILDINGS �����" CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 Sn i RECEIPT NO I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
fly/ CONNECT ADDITIONAL BLDG-OR d EXCEPTION RECORDED
Q WORK TO HOUSE SEWER 1 00 NO I DATE I BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATIONDEPTH
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CESSPOOL—DRYWELL
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SPECIAL CONDITIONS ONLY 200 �/ i� HOLEREFEREN E/ LOWER
1 TYPE OF CONNEeflON LE 6TH F66M �� r
OWNERS PERMIT $ I I 00 'Y--_ CURB PIL— M L TO P L Cl
AUTHORIZATION I TOTAL FEE V v'
I HAVE TH S DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGIj APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER\
SIGNED THIS �✓` DAY OF \ - Iq.S �I NEW HOUSE SEWER DM�-I}t.G..
OWNER OR " , I CONNECT ADDITIONAL
OWNERS AGENT�` on�-"I `\ �QM-Aat� BUILDING OR WORK
ADDRESS r \ h SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
v
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL I] DRYWELL
CAT
IONAND STATE THAT THE ABOVE IS CORRECT AND AGREE El
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED6
D
ANCR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE_OF,_CALIFO RNIA-OR THAT I AM THE LEGAL OWN ( ABANDON HOUSE SEWER
ER F THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
L
NRE t 1 � SEEP PIT(S)E3 CESSPOOLS�PERMITTEE »'JJJLLL _
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