The URL can be used to link to this page

Home My Public Portal About5657 CAMBURY AVE_Sewer__ t -24650 INSER CEA08 °° APPLICATION• FOR PERM T � 'Tsnsazo COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL , DEPARTMENT OF COUNTY ENGINEER - BUILDING AND SAFETY DMSION BUILDING Stiti ADDRESS+ WILLIAM A.IENSENC Su y of°Sandi. - - I P 4 LOCALITY '-lp�' _ FOR APPLICANT TO FILL IN CROSS'S sT. LEGALVYXl / OWNER DESCRIPTION LOT NO, _ BLOCK TRACT MAIL ADDRESS NO.OF tLDGS. SIZE OF LOT - NOW ON LOT KZ CITY TEL, NO. USE OF DISTRICT NO. GROUP MAP PROCESS50/113T BUILDINGS BK PIS CONTRACTOR ADDRESS CTION DATA CIT `r TEL.NO©� CO Qr TION DEPTH T REGISTRATION NO./{pOS7,/' STATE MANHOLE REFERENCE NO. DESCRIPTION OF. K FEE /; LOWER { HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM ^p [ SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. oG J PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. CESSPOOL. DRYWELL @ S2:LOO HOUSE SEWER CONNECTING TO P.O.N0. PRIVATE DISPOSAL SYSTEM @ SI.00 CO.IMP. N0. /'3 JOB NO. p CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT NO. ROAD PERMIT NO.. V _ WORK TO HOUSE SEWER @ 51.00 ALTER, R PAIROHR ABAL SYNDON HOUSE @ $I 00 STATE ENCROACHMENT _ {5 I SEWERPERMIT NO. M INDUSTRIAL V "- WASTE APPROVAL w 7 CHARGES OWNER'S PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION' TOTAL FEE 40 ` REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING- - "APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR 4A� CONNECT ADDITIONAL OWNERS AGENT /OO BUILDING OR WORK ADDRESS AND/DR TANK,SEEP.PIT(S) DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS ATO CO TION - - - - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR PLUMBING'ANDBEWERS. - SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND - LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER ' CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP RTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.P T(S) ❑ CESSPOOLS OF PERMITTE ®. VALIDATION--1 ROBERT.A. WOOD °K. M.O. " usx - SUPERVISING MECHANICAL ENGINEER Lf�urr rD 5 / v ar 1'Y1f 1 I 17 2 .5-00 ' P ' i 24650 INSERTS CEBOB 600 APPLICATION FOR PERMIT Teneazo COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL . DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS' PORN A. L DENSE, County of Building WILLIAM A. JENSEN. Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL L-/�' DESCRIPTION LOT ){s/ OWNER BLOCK TRACT % MAIL ADDRESS NO OF LDGS. SIZE OF LOT OW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCES D BY BUILDINGS A ^ BK PO / CONTRACTOR �� 57 L/ I- ADDRESS o _ t 1, CONNECTION DATA CIT TEL.NO ION DEPTH 32!1 / [] ST�AT�E�� MANHOLE REFERENC REGISTRATION 10. �1 '}� J.4.iWAR6W P LOWER No. DESCRIP ION OF O FEE _ HOUSE SEWER CONNECTING TO PUBLIC SEWER Cv $3.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK, PITS AND/OR DRAINFIELD IT OR @ S3.00 SEEPAY. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN..CESSPOOL. ORYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ SI.00 CO. IMP. N0. JOB N0. �. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO V WORK TO HOUSE SEWER @ SI.00 ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT I r4 SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. O INDUSTRIAL U .. WASTE APPROVAL W CH44 ARGES OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE 3✓ oA AUTHORIZATION TOTAL FEE Q REIMBURSEMENT FEE CON- TRACTOR TO CIONNECT THE ABOVE DESCRIBED XIISTDATE A CONTRACT WITH THE IINGAMED DWELLING APPROVALS DATE, INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS AlDOF19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT !/2 V BUILDING OR WORK SEPTIC TANK,SEEP.PITS) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [IDRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEW ER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE WER DESCRIBED RESIDENTIAL PROPE TY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SE PIT(S) ElCE SPOOLS OF PERMITTE ®P VALIDATION ROBERT A. WOOD CK. M.O. u6H SUPERVISING MECHANICAL ENGINEER e2 7 L;__36 5 7 7 � �`:IY :_ = D 5�r/r,- 1, y: