HomeMy Public PortalAbout6247 AVON AVE_Sewer__ 8@Ev6a It 55 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles AD RESSG
JOHN A LAMBIE COUNTY ENGINEER
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO
MAIL
BLOCK TRACT .�� �j 3 ADDRESS ..
[ � v ' NO OF BLDGS
x
SIZE OF LOT NOW ON LOT CITY L NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP
G GU
BK PG
CONTRACTOR �/� .� 107-
ADDRESS 1 CONNECTION DATA, - `
CITY TEL NO T 3 9 STATION DEPTH
MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRATION NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION L NGTH OM
HOUSE SEWER CONNECTING TO Y CURB P L M T L
PUBLIC SEWER @ $3 50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD n $3 00
OVERFLOW SEEPAGE PIT DRAINFIELDCO IMP NO P B O
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG ORSTATE ENCROACHMENT
�'
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PEST $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE p p
1 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 SEW �'YJ NEW HOUSE SEWER
SIGNED THIS DAY OF 19� CONNECT ADDITIONAL � / ems,
OWNER OR BUILDING OR WORK 7-j OV
//,
OWNERS AGE. (ZASEPTICTANK SEEP PIT(S)
ADDRESS
f AND/OR DRAINFIELD
I HEREBY ACKN6VILEDGE THAT 1 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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF D
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LIABANDON HOUSE SEW D
CALIFORNIA OR THAT I AM THE/// LEGAL OWNER OF THE ABOV
ER
DESCRIBED REST TIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE / SEEP PITS) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE COUNTY ENGINEER VALIDATIO ROBERT A WOOD CHIEF PLBG INSPECTOR
CK 61 0 CASH
LAC0
`73QOQ, 'APR 2? 4 200 �
r
D
S&E 663 3 SS
APPLICATION FOR PERMIT' 1
S&E 8
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY ) D
FOR APPLICANT TO FILL IN NEAREST
CROSS ST /(
LEGAL ,�p1 Bd_
DESCRIPTION LOT NO �Y ^`' OWNER 04MAIL
�
BLOCK TRACT S J ADDRESS CiC�wL.
NO OF BL / ,���
SIZE OF LOT -D NOW ON LOTT CITY Z TEL NoAT
USE OF
BUILDING 1Z� DISTRACT NO GROUP /may MAPBK P
r�
CONTRACTOR (/ 'L/ i 155' J—
ADDRESS /-• L G
CONNECTION DATA
CITY TEL` TEL NO - ' (� STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO ❑ COUNTY LOWER
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y CURB P M L TO P L
PUBLIC SEWER @ $ 3 50
HOUSE SEWER CONNECTING TO ^ M `/
f/�j tJ I
PRIVATE DISPOSAL SYSTEM f 00 `J �/
_ yam—
CONNECT ADDITIONAL BLDG OR P C NO
WORK TO HOUSE SEWER 100 CO IMP NO JOB NO
ALTER OR PEPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK SLEPAGF PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S $ 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
IHAVE MED CON
TRACTORTOCONNECT DATE O THE ABOVE WDESCR BED EXISTING ITH THE HEREIN A DWELLING APPROVALS DATE INSPECTOR SSIGNATURE
TO THE PUBLIC SEWER /�{/l
SIGNED THIS DAY OF Oal ' /Jf) 19y NEW HOUSE SEWER
OWNER OR /n` L/`C\�.1�(� CONNECT ADDITIONAL
OWNERS GEy^ �J�i l BUILDING OR WORK
ADDRESS /�V,� ��/I/-��'� ���.._I GL�./V SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I0ACKNOWLEDGE 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABODE ABANDON HOUSE SEWER
DESCRIBED RESIDENT ALT ' BACKFILL SEPTIC TANKS C
� SEEP PIT(S) ❑ CESSPOOLS❑
SIGNATURE �.
OF PERMITTEE
WILLIAM J FOX COUNTY ENGINEER VALIDATION R A WOOD CHIEF PLBG INSPECTOR
iCo 9 2 6 r,- OCT 21 4 200
r ,% �