HomeMy Public PortalAbout4946 CAMELLIA AVE_Sewer__ TEMPLE COTY
T°A°'°°
CE808 B-pp APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER ..
BUILDING AND SAFETY DIVISION ADDRESS
E� ADDRESS ` G L./. A`J<•
C IA SA1T D.GRIFFIN PI t of Building
LOCALITY cc
FOR APPLIC��A✓✓NFT'T TO FILL
LEGAL UJ AI
DESCRIPTION LOT NO. OWNER
BLOCK (( TRACT MAI L
ADDRESS C ;� /- L-LLiI)- P/4
SIZE OF LOT tJ ��d NO.OF NOW ON LOTS cm7!7E �o , TEL. NO. 47- 4;0-217
. USE OF //3 n ,. ..
BUILDINGS F ' ERIC F- U{I fL/•/ F• DISTRICT N0. GR BK MAP
PG I PROCESS BY
CONTRACTOR '
ADDRESS ` CONNECTION DATA
CITY STATION 'DEPTH
TE MANHOLE REFERENCE - UPPER
REGISTRATION NO. COUNTY LOWER
No. DESCRIPTrON OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ .00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ 2.00
HOUSE SEWER CONNECTING T0. P.C.NO.
PRIVATE DISPOSAL SYSTEM @ .00 CO.IMP. JOB NO.
WORCONK TO ADDITIONAL
ER LOG.OR @ 00 TRUNK PE MIT N0. ROAD PERMIT NO.
LTE OEDISPORASAL 9ASTE M HOUSE @ 00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 DU CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 0-0 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 SEW R
' SIGNED THIS DAY NEW HOUSE SEWER
OWNER OR ' CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADORES SEPTIC TANK,SEEP.PIT(S)
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 I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER At- 1
PLUMBING AND SEWERS. SEWAGE'BFSpOBpi 9Y�TEM /•L �(/yN/ s
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND /•2
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER /
• CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE IAL PROPERT BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PITS ❑ CESSPOOLS Ll
OF PERMITTE
®�
VALIDATION--,N ROBERT A. WOOD
m A.0. Q u SUPERVISING MECHANICAL ENGINEER
(AGpl 9 2 X20 t o n 5.00- e