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Home My Public Portal About4814 CAMELLIA AVE_Sewer__ D S&E-669 1199 APPLICATION FOR PEPERMITS 8 �8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer '- County of Los Angeles BUILDING /� ^��i1 ` �e JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ! `L /•1 ® CASSATT D. GRIFFIN. SUPT OP BUILDING LOCALITY pL` FOR APPLICANT TO FILL IN caoss sr zz'LflcR /q Zy 5 LEGA DESCRIPTION LOT NO. S"4 OWNER o fl7N MAIL BLOCK TRACT// /L{�6 7 ADD R ESS �t rJRC�OFY• �J S(O/^ ^ NOWOON LOTS W � CITY . C (/j�tJ� TEL. NO. D % SIZE OF LOTU SE OF f. c BUILDINGS Alt, DISTRICT NO. GROUP MAP BK PG CONTRACTOR CONNECTION DATA ADDRESS STATION DEPTH CITY TEL. N0. MANHOLE REF RENCE_ _ UPPER ❑ STATE LOWER REGISTRATION N0. ❑ COUNTY _ /f No. DESCRIPTION OF WORK . FEE �l(f HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FR6M PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ S 3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD CO. IMP. N0. JOB NoO. . EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM © $1.00 # TRUNK PERMIT NO ROAD PERMIT NO, CONNECT ADOITIO NAL BLDG.OR STATE ENCROA MENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. l ALTER,RCN HOUSE _ INDUSTR —{/— SEWER ORIDISRa GALS>LGZEM © $1.00 - WASTE PROVAL CHARG "' CONNECTION CHARGE FEE OWNERS PERMIT $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPEC OR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER 4-al SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR k BUILDING OR WORK y J 4 OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD . I 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 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 I AM THE LEGAL OWNER OF THE A VE _ DESCRIBED R AL PR ERTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS[I OF FERMI JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR CN. Y.0. ASN L�ic07.615APR29 4 3.0 0 .