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Home My Public Portal About5415 CAMBURY AVE_Sewer__ i 76A642D CE8os s-saAPPLICATION FOR PERMIT -' cse . COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUILDING IOHN A. LAMBIE. Couutp EDgiaeer ADDRESS CASSATT D. GRIFFIN, Sup I of BOdiw LOCALITY c ' NEAREST 17 FO PLI ANT CROSS ST. LEGAL ry DESCRIPTION LOT N0. OWNER MAIL BLOCK TRACT D U { 07� ADDRESS �NO,OF J'/q SIZE OF LOT J ,S R I O NOW ON LOT BLDGS� CITY TEL. NO. ' b'iF/ t� USE OF - .. BUILDINGS DISTRICT NO, GROUP I �B�MAP I P ESSED CONTRACTORLr ADDRESS " CONNECTION DATA CITY TEL.NO. 4?./O+ STATION DEPTH 50—IREGISTRATION N0. e,70TATE MANHOLE REFERENCE COUNTY i LOW NO. DESCRIPTIONOFWORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROMSEPTIC TANK, <J A PITS AND/OR DRAINFGELDT OR @ 53.00 Y. CURB P.L. M.L.TO P.L. C), OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. CESSPOOL. DRYWELL @ SZ.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ SI.00 001Y8rN'O. JOB N0. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO WORK TO HOUSE SEWER @ SI.00 �• SEWER OR DAI SPOSAL SYSTEIR OR A6ANDOM HOUSE @ 5100 STATE ENCROACHMENT PERMIT N0, INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ Z 00 CONNECTION CHARGE FEE . AUTHORIZATION TOTAL FEE � REIMBURSEMENT FEE n r n) 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- •V XV TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF-11 F 19_ - NEW HOUSE SEWER it-17•(,c OWNER A /y ;r CONNECT ADDITIONAL OWNERS AGENT V !� BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL 0 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. c SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP. PIT(S) '❑CESSPOOLS 0 OF PERMITTER ©. L4 e G ct i0VALIDATION ROBERT A. WOOD - CK. Y.o: CASH SUPERVISING MECHANICAL ENGINEER IAC.8945n AN 78 G A 165.00 r 4 1;a8 9. 4 6IT-'1 7 1 0 A 5.00 M