HomeMy Public PortalAbout6251 AVON AVE_Sewer__ 62
76A64262
APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A LAMBIE County Engineer ADORE 55 6
WILLIAM A JENSEN Sup t of Building '�
LOCALITY wgr I-
I I
NEAREST
FOR APPLICANT TO FILL IN CROSS--T ,,46 Al tV1 v
LEGAL
DESCRIPTION LOT NO -30 OWNERIT
\
MAIL
BLOCK TRACT O ADDRESS
`� 'nom NO OF SLOGS
SIZE OF LOT/ 7 l7"'-� NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESSE Y
BK PG d
CONTRACTOR �A �� /11 2,
ADDRESS (,v r Vim¢ CONNECTION DATA
VZgSTATION DEPTH
CITY � TEL NO �3Q
STATE
CY MANHOLE REFUPPER
E C /n
REGISTRATION NO1 OUNTLOWER rC j/
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L d
PUBLIC SEWER Q $5 00
SEPTIC TANK SEEPAGE PIT OR PC NO
PITS AND/OR DRAINFIELD @ S1000 CO IMP NO JOB NO V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $3 00
CONNECT ADDITIONAL BLDG ORf3 AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300 (�-'(�
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $500 HWY OR 5T WIDENING
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ S300 I STATE ENCROACHMENT c
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNER S PERMIT 2 O0 CHARGES
AUTHORIZATION TOTAL FEEG-c> CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF fig_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_
CONNECT ADDITIONAL /n41
ADDRESS BUILDING OR WORK
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 ❑
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT IAM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE DESLRI BED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE /e/ P BACKFILL SEPTIC TANKS ElOF PERMITTE / SEEP PIT(S) El CESSPOOLS ❑
VALMATION ROBERT A WOOD
M O CASH SUPERVISING MECHANICAL ENGINEER
LE078751 DEC 51 0 A 500 -
76AG42D j,
63 3 35 APPLICATION FOR PERMIT
E eDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer a� / t . y
County of Los Angeles BUILDING
_Z� / S,rt� �a
WM J FOX COUNTY ENGINEER r
CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY`) f
FOR APPLICANT TO FILL IN CROSS r
LEGALDESCRIPTION LOT NO J � OWNER
BLOCK I TRACT , ADAIL
DRESS �I
NO OF BLDGS f
SIZE OF LOT(I NOW ON LOT I CITY r TEL NO
USr OF
BUILDINGS f !1 . DISTRICT N.1 GROUP BK MAP FG
CONTRACTOR ��-r,.?�••Y� Vg�/ I /� la/G
ADDRESS S*� ,� cr f' 7'--- CONNECTION DATA 2
T o q
CITY L„ . TEL NO STATION DEPTF� e,J
❑ STATE MANHOLE REFERENCE7 �' UPPER
REGISTRATION NO /> [I COUNTY
No DESCRIPTION OF WORK FEE
TYPE ECTION LENGTH FROM �/ d
HOUSE SEWER CONNECTING TO O Y CURB P L M L TO P L �C
PUBLIC SEWER Q $ 3 50
HOUSE SEVER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 _
CONNECT ADDITIONAL BLDG OR P C NO
WORK TO HOUSE SEWER1 00 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO 31 M-7
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANY SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTPIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
OWNERS PERMIT g 1 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE I 3w REIMBURSEMENT FEE
1 HAVE THHIS DATE CONTRACTED WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO ThE PUBLIC SEVER 00
SIGNED THIS �� klQAY OF 19 r1 NEW HOUSC SEWER
OWNER OR $'� CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I0ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[3AND STATE THAT THE ABOVC 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 REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SE '
9EEP".Pfl CESSPOOLS -�7 //le, �J✓
SIGNATURE � iK�Jv'►_
OF PERMITTEE -
WILLIAM J FOk COUNTY ENGINEER VALIDATION FLA WOOD CHIEF PLBG INSPECTOR
DC' 4 9 1 y- APR 10 4 4 50 In