HomeMy Public PortalAbout5239 CAMELLIA AVE_Sewer__ APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dep . of C _21T End.«
Co—op of " An"limF11
DtNa a
JOHN A. LAMBIE, COUNTY ENGINEER KRSm CASBATT D.GRIFFIN, SUPT of BUILDING LITTFOH APPLICANT TO FILL IN m ST.
LEGAL
DTSCRIPTIONLOT N0. OWNER
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BLOCKTRACT ■
CD .JADDRESS
ww / �J N0. OF IILDGS. CITY TEL X0.
SIZE OF'LOT '�"1� •(( NOW OX LOT
USE
OF
BUILDINGII DISTRICT NO. GROUP MAP
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BK Pq
CONTRACTOR . I 'q1/O
ADDRESS , ` CONNECTION DATA
y STATION DEPTH
CITY TEL NO.Q C 7�
,•MANHOLE RTFHRENCE UPPER o
❑ STATE LONER
REGI-STYATIOX NO, ❑ COUNTY
No. DESCRIPTION OF WORK FEE o
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER $3.30 Y. CURB P.L. Y.L. TO P.L.
3EFTIC TANK,SEEPAGE PIT OR
P AND/OR DRAINFIELD 3.00
OVERFLOW SEEPAGE PIT,DRAIN-FIELD O 0. P. C. 110.
i
EKTN.,CESSPOOL,DRYWELL MANHOLE 2.00 Co. IMP. NJOB N0. -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM -8 $1.00 TRUNK PER_MIT�Q. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.6R �}...n STATE ENCROACH T
i
WORK TO HOUSE SEWER Qs 1.00 C! V PERMIT
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISP09AL SYSTEM Q 1.00 WASTE APPROVAL
CHARGE!
CONN£ CHARGE FEE
OWNERS PE MMT • i t 00
AUTHOREZATION TOTAL FEE IMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- APPROVALS DA INSPECTOR'SSIr,NATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED E"I TING DWQLLING
TO THE PUBLIC SEWER. _ `` ����••.(� NEW HOUSE SEWER
SIGNED THISA O b lf>�Zdq CONNECT ADDITIONAL .
OWNER OR BUILDING OR WORK
11XER. AGENT ! SEPTIC TANK,SE[P,PIT(B)
ADDR AND/OR DRAINFI LD
1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AX-D STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITI-r ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT IAN PROPERLY REGISTERED AND/OR DISCONNE
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CT PLU&AND ABANDON CT PLEWER
CALIFORNIA OR THAT I A THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA P ERT-Y. BACKFILL 3EP�IC TANKS❑
SIGNATURE BEEP.PIT(S) CESSPOOLS❑
OF PERVITTEE
JOHN A. LAMBIE, 6OUNTY ENGINEER VALMATIO ROBERT A.WOOD, CHIP'PLBG. INSPECTOR
CX. IA,2 7 �� Nov 27 4 2.00 0