HomeMy Public PortalAbout6263 AVON AVE_Sewer_11/1/1956_house sewer connect to public sewer D
5&E 689 11 59
APPLICATION FOR PERMIT 1
S&E 8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGAL OWNER
DESCRIPTION LOT NO fJd
p ev
BLOCK TRACT MAIL J/ ADDRESS
NO OF BLDGS CITYMtjd TEL NO"
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO GROUP MAP
K PG
CONTRACTOR - 1 `. r /Y I
ADDRESS CONNECT N DATA .d.
CITY TEL NO
STATION s DEPTH /
�jyy
MANHOLE REFERENCE G� UPPER
STATE 0�
REGISTRATI N NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE
TYPE OF ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 50 Y URj P L M L TO P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO 3V O
EXTN CESSPOOL DRYWELL MANHOLE Q $2 00 !OB N
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
LZ
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST G DWELLING e
TO THE PUBLIC SEW19" NEW HOUSE SEWER h-r CQ °Jip
SIGNED THIS DAY QfF 9 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERSGEN ((/rrr��� ° SEPTICTANK SEEP PITS)
ADDRESS 10 3 JVID 12AL AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING METER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1ICHEREBY CERTIFY THAT I AM PROPERLY ISTERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES TY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE AL WNER OF TH ABOVE
DESCRIBED RESIDENT PROPER T BACKFILL SEPTIC TANKS❑ �� /
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS �j
OF PERMITTE
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JOHN A LAMBIE NTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
`_ ( _ 1 9 4 CAS2 NNOV 1 4 450 In