HomeMy Public PortalAbout5933 AVON AVE_Sewer_4/26/1965_sewer connection CE808 10-63
IT
76A6420 APPLICATION FOR PIGIYM
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADORE ss 5933 N. Avon Ave
WILLIAM A. JENSEN, Sup't of Building LOCALITY San Gabriel
'
NEAREST Leslie O
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. 6 OWNER Weber
Dev
/'1
MAIL
• BLOCK TRACT 29908 ADDRESS 5926o C . Blvd, ,
NO. OF SLOGS. 1 TO CO`�{^ TEL. NO.
SIZE OF LOT NOW ON LOT CITY
USE OF
BUILDINGS - DISTRICT NO. GROUP MAPS PROCESSED BY
- CONTRACTOR
ADDRESS Henry B . Vega CONNECTION DATA
;
�r STATION DEPTH
CITY O €La�D.' ve O
O
o MANHOLE REFERENCE
REGISTRATIO COUNTY 7 r ✓ LOWER
NO. DE F WORK FEETYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ S5.00 PC NO O
SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO.
PITS AND/OR DRAINFIELD @ SIO.00 . JOB NO. L V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00 ^
CONNECT ADDITI L BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE �
WORK TO HOUSE ER @ $3.00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD LU
EXTN.,CESSPOOL.DRYWELL,MANHOLE @ S5.00 C
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING H
SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s 2 00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
7 TRACTOR T0C ONNECT-THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLISEWER. APPROVALS DATE INSPEC'TOR'S SIGNATURE
SIGNED THIS DAY OF 19_ ':;
OWNER OR NEW HOUSE SEWER .J
OWNERS AGENT New
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 ORD CES AND STATE LAWS REGULATING
PLUMBING AND SEW CESSPOOL ❑ DRYWELL ❑
I HEREBY CER THAT AM PROPERLY REGISTERED AND�OR ALTER.REPAIR,SEWER OR
LICENSED AS UIRED BY LOS ANGLES COUNTY AND TATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA THAT I q•M�THE LEGAL OW R OF. AND INTEND TO
RESIDE IN, E
ABOVE,
E�DESCRIBED RES TIAL RO ERTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIGNATUR
OF PER E BACKFILL SEPTIC TANKS ❑
SEEP,PIT(S) ❑ CESSPOOLS ❑
VALIDATION,,., ROBERT A. WOOD
CK. M.O. CASH
SUPERVISING MECHANICAL ENGINEER
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