HomeMy Public PortalAbout6243 AVON AVE_Sewer__ J
76A 642D-CE9DB-10-71 `APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING
ADDRESS C
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ADDRESS
NO. OF BLD S. '-
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP OCESSED BY
8K PG
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y
60NTRACTO )/� /V'1\ / V
ADDRESS "`✓✓✓ CONNECTION DATA
CITY TEL. NO. 2.� S ATION DEPTH
STATE L C M NHOLE REFERENCE UPPER
LICENSE NOC!�?,_ Q0 CLASS Z7_ __ LOWER
NO. DESCRIPT'10tl OF WORK FEE YPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. URB P.L. M.L.TO P.L.
PUBLIC SEWER @ $7.00
To'P.C.
SEPTIC TANK.SEEPAGE PIT OR JOB NO.
PITS AND/OR DRAINFIELD @ $10.00 CO. IMP. NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $3.00 TRUNK PERMIT NO. ROAD PERMIT NO. O.
O
CONNECT ADDITIONAL BLDG,OR AFFIDAVIT I WhmR 'EASEMENT RECORD.INSTR.NO. DATE U
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD w
EXTN..CESSPOOL.DRYWELL.- @ $5.00 O
ON001101116 ABANDON HOUSE /f HWY.OR ST.WIDENING
. 9 DISPOSAL SYSTEM @ $3.00 �" STATE ENCROACHMENT
MANHOLE @ $7.00 PERMIT NO. a,
INDUSTRIAL H
WASTE APPROVAL
CHARGES
OWNER'SPERMIT $1 31 00
AUTHORIZATION TOTAL FEE 1
CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING �-I
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO cB+SGONN E6-i P-�L6-A'RV >+7
RESIDE IN, THE ABOV SCRIBED REST ENTIAL PROPERTY. ABANDON HOUSE SEWER --�2_2-7,7
SIGNATURE ❑
OF PERMITTEE BACKFILL SEPTIC TANKS
SEEP.PITS) ❑ CESSPOOLS
�^a
VAGI ATION CrK. ) M.O. CASH
76A 642D-CE808-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS Y t•��'f N.Avon Avon Ave.
LOCALITY Temple City
FOR APPLICANT TO FILL IN NEAREST Lon den
CROSS ST.
LEGAL Ray Moser
DESCRIPTION LOT NO. OWNER �1.7 T�yyr
� W. Woodruff
BLOCK TRACT O
� MAIL
NO. OF BLDGS. 1
ADDRESS
71
SIZE OF LOT-5 U X ' 2-0 NOW ON LOT CITYArcadia TEL. NO.
USE OF Res .BUILDINGS 1] DISTRICT NO. GROUP MAP P CESSED BY
/y G BK PS �
CONTRACTORS care Deal Sewer Service .0
ADDRESS 2 Maxson Rd. C/ CONNECTION DATA
CITY El Monte TEL. No- 444-2020 STATION /�O ,S DEPTH 7'
STATE LICENSE N...1.28870 LIl .�4 MANHOLE REFERENCE Z0477,�,5 (Z7 , LOWER^
NO. DESCRIPTION OF WORK FEE TYPE OF 1 N LENGTH FROM
1. OBLIE SEWER CONNECTING TO Y. CURB M.L.TO P.L.
PUC SEWER @ $7.00 00
SEPTIC TANK.SEEPAGE PIT OR 3� a P.C.NO.
PITS AND/OR DRAINFIELD @ $10.00
CO.IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM 83.00 !/ - C)
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wMIEq 'EASEMENT RECORD.INSTR.NO. DATE u
WORK TO HOUSE SEWER @ 83.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL. @ 85.00 O
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM @ 83.00 STATE ENCROACHMENT W
MANHOLE $7.00 PERMIT NO. 0-
INDUSTRIAL
INDUSTRIAL N7
WAS E APPROVAL b
OWNERS PERMIT $ 3 00 GES a
AUTHORIZATION TOTAL FEE 1.0 00 CONNECTION CH RGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING-
TO TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
r
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING [IPLU Me ING AND SEWERS. CESSPOOL ElDRYWELL
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RESIDENT L PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TARKS ❑
OF PER MTTTE SEEP.PIT(S) ❑ jPOOLS ❑
ALIDATION CK. M.0. CASH
6 8 4tZAPR 24 10 U 1