HomeMy Public PortalAbout4841 CAMELLIA AVE_Sewer__ 76A 42D 11.55 APPLICATION FOR PERMIT 40`
.DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer - - - - -
County of Los Angeles ADDRESSBUILDING /1/ /!Am '
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ^IlF4 T L c—t- L?.'4'
® CASSATT D. GRIFFIN, SUPT Or BUILDING LOCALITY \
FOR APPLICANT TO FILL IN
NEAREST
aoss.T.
LEGAL
DESCRIPTION LOT NOOWNER
BLOCK TRACT iA{A/b7 ADDRESS fy�� p
EL. NO.
/� NO. OF BLOCS.
SIZE OF LOT. ���170 NOW ON LOT CITY � •
USE OF !
BUILDINGS DISTRICT N0, GROUP MAP
CONTRACTOR 7QN� �` 0 � y ! z �✓
J1S v 21 ✓may 2'
L
ADDRESS ` a_ Cfi/7pS CONNECTION DATA
CITY —/�Q�7 j TEL. N0. �I • STATION y & ^[J DEPTH tf
MANHOLE REFERENCE UPPER
r� ❑ STATE LOWER
REGISTRATION NO. / 'L3 �a 7 Q A
NO. DESCRIPTION OF WORK FEE L` b
HOUSE SEWER CONNECTING TOTYPE OF CONNECTIO! LE GTH FROM
PUBLIC SEWER @ $3.50
Y. CURB L. A.E.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00.
OVERFLOW SEEPAGE PIT,DRAINFIELD C. NO.
EXTN.,CESSPOOL,ORYWELL,MANHOLE @ $ 2.00 ' CO. IMP. NO. B NO.
HOUSE SEWER CONNECTING TO
PRIVATE'DISPOSAL SYSTEM @ $1.00 y TRUNK PERMIT NO. ,R AD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR �r� STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 V PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER.OR DISPOSAL SYSTEM C, $1.00 WASTE APPROVAL
CHARS
CONNECTION CHARGE FEE
OWNER'S PERMIT $ I o0
AUTHORIZATION TOTAL FEE 00 REIMBURSEMENT FEE
HAVE AT THIS GATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS GATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER _ t
SIGNED THIS D� )9_ CONNECT ADDITIONAL
WORK
OWNER OR ! /� BUILDING OR WORK
OWNERS AGENT }� I SEPTIC TANK,SEEP, PIT(S) V
ADDRESS AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT i 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. 7 SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CO TV AND ATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM T E LEGAL 0 ER'OF ABOVE
DESCRIBED RES TIAL
OF Y. - BACKFILL SEPTIC TANKS E3G
SIGNATURE (. SEEP. PIT(5) ❑ CESSPOOLS ElOF PERMITTE
JOHN A. L'AM .COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CKI Y.0. CASH
ItyUp 6 2 9 MAR 2 cam. 4 2 .0 0 ui