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Home My Public Portal About6256 AVON AVE_Sewer__ 62 76A64262 APPLICATION FOR PERMIT 6A842 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /�O JOHN A LAMBIE County Engmeer ADDRESS {{�� WILLIAM A JENSEN Sup t of Buildmg LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL JvDESCRIPTION LOT NO OWNER MAIL BLOCK TRACT "o-a ADDRESS M E NO OF BLDGS 12/ SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY -1 m5BK PG /� CONTRACTOR (J`(lC,��f ADDRESS .4F % CONNECTION DATA CITY TEL NO �+ �Q STATION I� r n DEPTH ❑ STATE C UPPER REGISTRATION NO ❑ COUNTY MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TO P IL Q. PUBLIC SEWER @ $S 00 O SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ $10 00 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NOROAD PERMIT NO ix PRIVATE DISPOSAL SYSTEM @ $300 ' CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ 3300 r OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $S 00 OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE HWY FyoT SEWER OR DISPOSAL SYSTEM @ 5300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ z 00 CHARGES AUTHORIZATION I TOTAL FEE o_0 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO COVNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS-DAY ))OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL �� n BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) b 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 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 M HE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DE RI BED RESIDENTIAL ROPERTY ABANDON HOUSE SEWER SIGNATURE -FILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M O SUPERVISING MECHANICAL ENGINEER CASH I_l1 ,0 `' �� S U LE k tll,l ?1 i o A 5 00- 2G'fl`f' DEPARTMENT OF COUNTY ENGINEER -� SEWER-SEWAGE DISPOSAL 1 �� DIVISION OF, BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J FOX, COUNTY EN13INEER I ADDREISS J S /J(/�IV �* FOR APPLICANT TO FILL IN LOCALITY BUILDING NEAREST ADDRESS 625254 Avon Ave, CROSS ST V s 1+ LOCALITYDISTRICT NO SERIAL NO PERMIT NO San Gabrielr Calif. c" osST A //b7O�sRs Longden RE�EIV�B B Ready for Inspection DATfi ISSU D OWNER Clark L. and Vada E. MGElroyMAIL ADDRESS 6252 Avon Ave. USE ZONE OCCUPANCY -MAPS" BK PG CITY San Gabriel TEL NO AT 7-4354 CONTRACTORJ CO IMP NO y(J ADDRESS JOB NO CITY �„ TEL NO 1—e &110407er TRUNK PERMIT NO a STATE REGISTRATION NO l/ d g COUNTY ROAD PERMIT NO �' k� Ell LEGAL = DESCRIPTION LOT NO So. 50 ft. of Lot wSTATE ENCROACHMENT $ PERMIT NO (f BLOCK TRACT 5903 INDUSTRIAL TE APPROVAL J v SIZE OF LOT 501 R 1910 1 NO OF BLOC NOW ON LOTS HS4 8G Ga CHARGES USOF BUE DINGS Residence & Garage CONNECTION CHAR FEE NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO r PUBLICSEWER @ $ 350 1/ O RECEIPT NO DATE BY hCUSE SEWER CONNECTING TO PPIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR D 1 / EXCEPTION ECORDED WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING NO I DAT\ I BY SEWER OR DISPOSAL SYSTEM 1 00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA SEPTIC TANK SEEPAGE PIT OR PITS AND/ORDRAINFIELD 200 STATION 12Y&�3s 45' DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 _.MAN PPEE,7FERENC $ ' .L/ LOWER TYPE )F�CON ECTIO J LENGTH FROM / OWNERS PERMIT $ I 1 00 tY � � �`� M L TO P L AUTHORIZATION TOTAL FEE I 3; I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR SSIGNAT RE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS 10th DAY or, Qot fiber 19.53 NEW HOUSE SEWER OWNEROR CONNECT ADDITIONAL OWNERS AGENT _ _ BUILDING OR WORT, ADDRESS 6252 Avon verme, Sad lel _ AND/OR DRAINFIELD IT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL 0 DRYWELL E F CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY iCERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN ER OF THE ABO; DESCRIBED RESIDENTIAL ffl0 ERTY BACKFILL SEPTIC TANKS I] SIGNATURE , f SEEP PIT(S)� CESSPOOLS OF PERMITTEE _ 76AG42D 663 1 03 D