HomeMy Public PortalAbout4803 CAMELLIA AVE_Sewer__ 76A642 .S, APPLICATION FOR PERMIT
TBA 6X20 �+ �+
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F��CA
LDING A�
JOHN A, LAMBIE. Courtly Evgieeer RESS ((; �Y
WILLIAM A. JENSEN. Sup'I of Building LITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. - 1 $
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT PAIL
ADDRESS
NO.OF BLDGS.
512E OF LOT NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR MONTEREY PARA PLUMING GU. ING. /B P6
ADDRESS 410 SO. GARFIELD - AIL-Y6U4 CONNECTION DATA
CITYIMAM I�RTEL.NpKK. G'1LIYUHIVIP STATION 9�13A S DEPTH
STATE MANHOLE REFEREN E � �
REGISTRATION NO, aJ COUNTY LOWER
NO. I DESCRIPTION OFF OR FEE
HOUSE SEWER CONNECTING TO i
PUBLIC SEWER @ $4.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH RO
PITS ANDICR DRAINFIELD @ 5 .00 Y. CURB P.L. Y.L.TO P.L.
OYERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CES SPOOL.DRYWELL @ 52 00 1
HOUSE SEWER CONNECTING TO O
PRIVATE 015 POSAL SYSTEM SI. 0 CO.IMP. N0. JO 0
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER EI 0 TRUNK PERMIT N0. ROAD PERMIT N0. y
ALTER,Rp PMi!'BR#BAIIGGN MOUSE ,,�./ STATE ENCROACHME O
SEWER M @ $I00 (J u PERMIT N0. V
INDUSTRIAL W
WASTE AtIMIRIVAL d
N
CHARGES Z
OWNERS PERMIT $ Q 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ) REIMBURSEMENT FEEL AI
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- ®�/jil(�/
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAIS ` DATES I INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OW N ERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK.SEEP.PITIS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEW ER•011
PLUMBING AND SEWERS. _SEWAGEOISPOSAL SYSTEM gulp
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND t
LICENSED AS REQUIRED BY -LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW ER
CALIFORNIA DA THAT 1 THE LEGAL OWN OF THE ABOVE DESCRIBED RESIDENTI OP/ER BACKFI LL SEPTIC TANKS ❑
SIGNATURE `" I SEEP.PIT(S ❑ CESSPDOLS
OF PERMITTE ' ✓�
VALIDATION ROBERT A. WOOD
B.0. GVM SUPERVISING MECHANICAL ENGINEER
__ L.O 7.Q_:;7-Q ,JUN26 1 0 1) 5.00