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Home My Public Portal About6255 AVON AVE_Sewer__ r CE808 3 62 76A642D APPLICATION FOR PERMIT A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / 4 JOHN A LAMBIE County Engineer ADDRESS �/ WILLIAM A JENSEN Sup t of BuElchng LOCALITY p 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 DISTRICT NO GROU MAP PROCESSED BY BUILDINGS BK PG/� CONTRACTOR ADDRESS >� i / CONNECTION DATA CITY i� TEL NO (y/�� A ON J . DEPTH REGISTRATION NO El STATE MANHOLE REFE N rj UPPER ` ❑ COUNTY r NO I DESCRIPTION OF WORK FEE Tj9'EOFcoAN9C.TIOW L NGTH FRO HOUSE SEWER CONNECTING TO Y U L M L TO P L O PUBLIC SEWER @ $S 00 SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINFIELD @ $1000 CO IMP NO JOB NO NN V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO D TE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOLDRYWELL MANHOLE @ $5 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL W TE APPROVAL OWNER S PERMIT $ 21 00 G, AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON REIMBURSEMENT FEE TRACTOR TO 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 /3 OWNERS AGENT ^�L,GJ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAI NFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY 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 DISCONNECT PLUG AND RESIDE IN THE ABO V ESLRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ��' SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER �,Eo0 2 4 0G JP) 23 1 0 R 7 00- CE11011 3 62 76A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING L--► JOHN A LAMBIE County Engineer ADDRESS �7 WILLIAM A JENSEN Sup t of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER ry� MAIL BLOCK TRACT ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS �'/✓ DISTRICT NO GROUP MAP PROCESSED ^� K PG B CONTRACTOR s/l' " ADDRESS ) lS" (401 CO ECTION DATA CITY TEL NO L., ��d7 S A ON DEPTH STATE MANHOLE F R CE UPPE REGISTRATION NOCOUNTY NO DESCRIPTION OF WORK FEE YPE F ON C LENGTH Fr HOUSE SEWER CONNECTING TO Y B M L TOP �! C/ PUBLIC SEWER @ $5 00 O C NO SEPTIC TANK SEEPAGE PIT OR P PITS AND/OR DRAINFIELD @ $1000 CO IMP NO O JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO 2 PRIVATE DISPOSAL SYSTEM @ $300 v CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY ORST WIDENING SEWER OR DISPO SA SY EM @ $3 00 STATE ENCROACHMENT PERMIT NO Vv Vv INDUSTRIAL WASW APPIR L OWNER S PERMIT s H G AUTHORIZATION 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 APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR J� NEW HOUSE SEWER n�// OWNERS AGENT C CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANKSEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI�A�ION AND/OR DRA I NFIELDANSTATE 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 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 1 AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE ESCRIBED RESIDENTIAL PRO ERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS C3T OF PERMtrTEE SEEP PIS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH p L,7 o O 2 4 1.o JAN 2 S 11 1 2 5 00- 5