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HomeMy Public PortalAbout6219 1/2 AVON AVE_Sewer__ 79A842D BE 8831264 APPLICATION FOR PERMIT 7 ' R 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL. Deportment of County Engmear County of Loa Angeles pDOREsS d Sf WM J FOX COUNTY ENGINEER CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEARESTLEGAL I �� CROSS ST DESCRIPTION LOT NO /,A COA e �J WNER BLOCK / TRACT 3 MAIL CY /O � ADDRESS NO OFBLDGS / SIZE OF LOT DNOW ON LOT CITY L NO USE OF BUILDINGS DISTRICT NO GROUP MAP PG CONTRACTOR �V ( I 3 I K /0 ADDRESS CONNECTION DATA CITY (� L NO STATION DEPTH ❑ STATEMANHOLE REFERENCE REGISTRATION NO I 8� _z;_4Q i14T* O UPPER TYPE OF CONNECTION LENGTH FROM NO DESCRIPTION OF WORK FEE Y CURB P L M L TO P L HOUSE SEWER CONNECTING TO .r L Q PUBLIC SEWER Q $ 3 50 HOUSE SEWER CONNECTING TO f�r� - /�s^0 S Qom. (��')f7k•'�7 PRIVATE DISPOSAL SYSTEM 1 00 / I.. CONNECT ADDITIONAL BLDG OR CO IMP NO © JOB NO WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO pT,9 9z DISCONNEuT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL DRYWELL HASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNER S PERMIT g 1 00 AUTHORIZATION TOTAL FEEI HAVE DATE S^p REIMBURSEMENT FEC CON TRACTORTHIS TO CONNECTO THE A13OVEWITH DESCRIBED EXITHE STINGAMED DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER — SIGNED ThISptDAY 0 rr11_ Ig_ NEW HOUSE SEWER OWNER CONNECT ADDITIONAL ON NERS G NT BUILDING OR WORK ♦ SEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY NOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[I 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 REGIST AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY D STATE F ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER F HE A E DESCRIBED RESIDENTIAL P ERTY ♦ BACKFILL SEPTIC TANKS❑ SEEP PITS) ❑ CESSPOOLS❑ SIGNATURE OF PERMITTE WILLIAM JO COUNTY ENGINEER VALIDATION { 1Y0 9 5; lit 3 4 4.5 0 m BY DEPUTYDEPUTY � ,s_ok9 TIS mm 3 5 10=.0 0 Q BY BY ,p T® DEPUTY /(� DEPUTY DEPARTAIEN'T OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTYI OF LOS ANGELES /�,.] `, Q WILLIAM J FOX, COUNTY ENGINEER ADDRESS BUILDING �� !/y FOR APPLICANT TO FILL IN LOCALITY BUILDING NEAREST j ADDRESS CROSS ST LOCALITY �y1 DISTRICT NO SERIAL NO PERMIT NO A zl c CNEAREST ROSS ST \ 25-��e a RECEIVED BYE Ready for Inspection DATE UED OWNER MAIL USE ZON OCCUPANCY ADDRESS �.2 � //�y �� BK PG CITY TEL NO CONTRACTOR CO IMP NO ADDRESS 7 G / JOB NO CITY TEL NO TRUNK PERMIT NO TA TE REGISTRATION NO ��a80iTNTY2 /J * � ROAD PERMIT NO LEGALSTATE ENCROACHMENT DESCRIPTION LOT NO � PERMIT NO BLOCK TRACT S Q 7J kINDUSTRIAL WASTE APPROVAL SIZE OF LOT aOW ON LOTS � CHARGES USEOF BUILDINGS NO DESCRIPTION OF WORK FEE .REI HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 350 RECEIPT NO ATE BY HOUSE SEWER CONNECTING TO a/ PR VATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR EXCE 10 ECORDEO WORK TO HOUSE SEWER 1 00 NO ALTER OR REPAIR EXISTING DATE BY 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 ( STATION CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE P-ER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y CURB P r M-t-TO-Fl AUTHORIZATION I TOTAL FEE �- ®�G z� I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED DWELACTOR TO CO NECT TSHE EW ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR 8 SIGNATURE DATE NG SIGNED THISF DAY OF � °� 19y � NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORKZ II01 i SEPTIC TANK SEEP PIT(S) / ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THA 1 HAVE READ THIS APPLI CESSPOOL[] DRYWELL CATION AND STATE THAT THE AB VE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLUPPBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS El SIGNATURE SEEP PIT(S)[-] CESSPOOLS OF PERMITTEE i 6A642D 663 1/53