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Home My Public Portal About4808 CAMELLIA AVE_Sewer__ .56E`0312.5• APPLICATION FOR PERMIT DMSION OF MELDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer j County of Los Angeles BUILDING / /11 WM. J. FOX. COUNTY ENGINEER ADDRESS Y n CASSATT D. GRIFFIN, SIIP'T oP EIUILDING LOCALITY FOR APPLICANT TO FILL IN f NEOASRESTT. !U✓izVS nt/ LEGAL CRS � J VL TIly C t DESCRIPTION LOT N0. OWNER / l KL BLOCK TRACT - A.MA.11. 13LIO rMKtg-w MNO OF SIZE OF LOT' NOW ONBLOTS CITY 64 e�( Q�j rt TEL. N0. aQ it) USE OF / BUILDINGS Wt .U./A/�/1//� (. DISTRICT NO. GROUP MAP CONTRACTOR 1i T/p'1�l/I Q/c0✓kr - I.� -T � ADDRESS3-j.s JIJ' %SA h-rA �}VM--7-7L ) V-A ✓ ) CONIiECTION DATA CITY C-(l Q(( (- TEL. NO.M/ -7-7 I ) 5 STATION / .•fo?/r DEPTH y REGISTRATION NO. 6 L.F�/z ❑ CO NTY MA UPPER NHOLE REFERENCE g/ r LOWER TYPE OF CONNECTION LENGT FROM NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M,L,TO P.L. HOUSE SEWER CONNECTING TOLT_ PUBLIC SEWER 0 $ 3.50 ILL/ HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00CONNECT ADDITIONAL ) /� WORK TO HOUSE SEWER BLDG. OR I.00 r✓✓ CO. IMP. N0. JOB. N0. VrsV 'ALTER OR REPAIR EXISTING (l SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO, DISCONNECT AND ABANDON SEWER STATE ENROACHMENT - AND/OR DISPOSAL SYSTEM 1.00 PERMIT N . SEPTIC TANK. SEEPAGE PIT OR _ PITS AND/OR DR.AINFIELD 2.00 - JNDUSTRI - CESSPOOL-DRYWELL WASTE APP OVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES - CONNECT] A GE FEE 'OWNER'S PERMIT S I CO AUTHORIZATION TOTAL FEE IQ REIMBURSEMENT FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DFcr^ISED EXISTING DWELLING APPROVALS DA E INSPECTOR'S SIGNATURE TO THE PUBLIC S WER / NEW HOUSE SEWER SIGNED THIS DAY OF d V L 1 OWNER OR,: CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK 11 -- SEPTIC ADDRESS AND/ORTDRA(NFIELO PIT(S)- ` 1 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 ALTER, REPAIR. SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM - I HEREBY CE Y THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 0 IRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA AT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED R SIO TIAL PROPERTY. BACKFILL SEPTIC TANKS❑ .., SEEP.PIT(S) ❑ CESSPOOLS❑ .SIGNATURE - OF PERM;, .. _ WILLIAM J. FOX, COUNTY ENGINEER - VALIDATION . s'er .. _Cc,a Ser (3zR JIL17 4 5.50 N . DEPUTY DEPUTY BY BY © ,t �� ' DEPUTY - wi[f-1.I DEPUTY ...