HomeMy Public PortalAbout5608 CAMBURY AVE_Sewer__ J8p84APPLICATION FOR PERMIT
Sfl E66DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPO AL
-Department of County Engineer -- .
,- County of Los Angeles ', BUT
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS Q
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN
NEARESTSS .
LEGAL /
* DESCRIPTION LOT N0. OWNER
BLOCK TRACT �/s :F MAIL
/ ADDRESS
l X l / N0. OF BLDGS. CITY TEL. NO.
SIZE OF LOT l NOW ON LOT
USE OF
BUILDINGS DISTRICT NOV` GROUP MAP
CONTRACTO _ K PG
ADDRESS CONNECTION DATA _
' CITY JSTATION DEPTH
P (f MANHOLE REFERENCE _ UPPER
❑ STATE LOWER
I N
REGISTRATO. /c ❑ COUNTY
NO. DESCRIPTION OF ORK FEE
TYPE OF CONNEC ON ENGTN FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEW ER @ 53.501
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P:C. NO.
EXTN.,CESSPOOL,DRYWELL.MANHOLE Q S 2.00 CO. IMP. N0. JOB NO.
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 0 S 1.00 TRUNK PERMIT NO. OAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q S I.DO PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE i INDUSTRIAL
SEWER OR DI POSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT § 1 00
AUTHORIZATION TOTAL FEE DO f REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED con- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE'NER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL LJ DRYWELL[IAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
If
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR 7
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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 W ER OF TH -.ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑.
SIGNATURE
SEEP. PIT(s) Ll CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER _ALLIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
V- ILGA
CASH 0' 3 9'M FEB 7 . 4 A 2.0 0