HomeMy Public PortalAbout6253 AVON AVE_Sewer__ 62
768042D APPLICATION FO R PERMIT
6A842
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE County Engineer ADDRESS
WILLIAM A JENSEN Sup t of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL �
DESCRIPTION LOT NO OWNER
✓ MAIL
BLOCK TRACT ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP ;PROCESSEDTBY
J B K ///P G
CONTRACTOR -le-2—/P-2—
ADDRESS 7 7 ONNECTION DATA
CITY STATION v DEPTH
14, tt TEL N L9 ✓2 J
STATE
MANHOLE REFERENCE
REGISTRATION NO Q COUNTY
• I
NO DESCRIPTION OF WORK FEE YPE OF CONNECTION LENGTH FROM 1
/ HOUSE SEWER CONNECTING TO CURB P L ML TO P IL cj a
PUBLIC SEWER @ 55 00 / /� P C NO O
SEPTIC TANK SEEPAGE PIT OR (,J P C NO
PITS ANDOR DRAINFIELD @ 51000 CO IMP NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO a`
PRIVATE DISPOSAL SYSTEM @ $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER I EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ 55 00
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING 9
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT 6i.
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PERMIT $ z 00
AUTHORIZATION I TOTAL FEE 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 INSPtOR S SIGNATURE
SIGNED THIS DAY OF / 19_ ' a
OWNER OR _ i/�/ NEW HOUSE SEWER e!
OWNERS AGENT_ {i
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 [IPLUMBING AND SEWERS CESSPOOL El DRYWELL
I HEREBY CERTIFY THAT 1 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 DISCONNECT PLUG AND
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSESEWER
SIGNATURE BACKFILL SEPTIC TANKS ElOF PERMITTEE SEEP PIT(5) ❑ CESSPOOLS ❑
VALIDATION ROBERT A WOOD
CK M O CAS
SUPERVISING MECHANICAL ENGINEER
s
L 1' 0 2 3 8 EIAt�J r?8 1 0 A 700-
�