HomeMy Public PortalAbout5930 AVON AVE_Sewer_4/26/1965_sewer connection 6A64 10-63 APPLICATION
IOP ICA TION ICOR PERMIT
76A642D P'il�l�l� f'i 1 ftl f-' PERMIT .
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, Supt of Building -930 Avon °
; LOCALITY S G
NEAREST
FOR APPLICANT TO FILL IN CR°SS ST. l��us cat e Ave,
LEGAL
DESCRIPTION LOT NO, 12 OWNER
MAILO
BLOCK TRACT 29908 ADDRESS
NO. OF SLOGS. TEL. NO. C.
Blvd .
T
SIZE OF LOT NOW ON LOT CITY J_ C
USE OF Resid .ence DISTRICT NOGROUP MAP P
BUILDINGS ROCESSED BY
CONTRACTORHenry B . �T �/w-� L
f ADDRESS324.9 N. Tirsr jklre
7,g CONNECTION DATA
SO ® San ry Q U�• e �j STATION DEPTH -,
CITY S /n. S Q A p�
REGISTRATION ' ,02 52 5 t .
❑ STATE MANHOLE REFERENCE
❑ COUNTY- /
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TOY. CURB M.L.TO P.L.
PUBLIC SEWER @ $5.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO. O
CO.IMP. NO. JOB NO. ml/
PITS AND/OR DRAINFIELD @ $10.00 V
HOUSE SEWER CONNECTING TO " TRUNK PERMIT NO. ROAD PERMIT NO. Ix
PRIVATE DISPOSAL SYSTEM @ S3.00 ^
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wA1vEN EASEMENT RECORD, INSTR,NO, DATE F
WORK TO HOUSE SEWER @ $3.00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD IIJ
_ EXTN.,CESSPOOL.DRYWEL L,MANHOLE @ $5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING N
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWR
NES PERMIT s z 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
'1 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 INSPECTORIt SIGNATURE
SIGNED THIS DAY OF 19_ x.
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL / T
hew BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PITS)
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 CERTIF&IRF
THA?1'1 PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUO ANGLES COU NTY.AND.ST TE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THH LEGALOWNED F, AND IN NO TO DISCONNECT PLUG ANRESIDE IN, THE AB ]BED RESIDE L PROPERT ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE KFILL SEPTIC TANKS El ❑
SEEP.PIT(S) ❑ CESSPOOLS
ALIDATIO ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
{
M.0. CASH .1 r �-/r } �
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