HomeMy Public PortalAbout5712 CAMELLIA AVE_Sewer__ ;��it-no APPLICATION FOR PERIVII
DrvISION OF WELDING AND SAFETY SEWER—SEWAGE DISPOSAL
D.x-b-.2>s oi Co—±y Enum.a
Ott of Los FB�JOHN A. LAMBIE, COUNTY ENGINSIIR CASJ3ATT D,GRIFFIN, SUPT OF BUILpING -RFOR APPLICANT TO FILL IN c> 58 TST.
GAL
DESCRIPTION LOT N0. / V / s7q IF
KKR
MAIL
BLOCK TR.ACT ADDRESS
110. 0 9 BLI?as. di
SIZE OF LOT NOW ON LOT CITY TEL, NO, V f�
USE OF DISTRICT 0. GROUP -- mAP
BUILDINGSA rJ+' B P�
CONTRACTOR Able Constr. J
CONr>�c.-riON DKTA
ADDREBS W t Bryant o
CITY El Monte TEL No.Gi 8— 5 65 STATION DEPTH
MANHOLE RHFHRHNCE
BTATH ,
REGLSTRATION NO. 168579 ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONXEtTINa TO S`, Y. CU P.L. Y.L.TO L.p7
TYPE 0 ION LENGTH FROM,
PUBLIC SEWER 3.50
SEPTIC TANK,SEEPAGE PIT 6g
PITS AND/OR DRAINFIELD Q 9.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
FF
EITN., SPOOL,DRYAELL MANHOLE 2.00 CO. Imp.N0. JOB NO.
HOUSE SEWER GONNECTIXa TO
I PRIVATE DISPOSAL SYSTE Q S 1.00 TRUNK PERMIT NO. -ROAP PERMIT 110.
CONNECT App ORAL BLDG.OR STATE ENCROACHMENT
FORK TO HOUSE SEA Q $1.00 PERMIT Mg. - -
ALTER,REPAIk OR ABAX-pON HOUSE INDUSTRIAL '
SEWER OR DISPOSAL SYSTEM ® 1.00 WASTE APPROVAL - - -
C HAR 0 ES
CONNECTION CHARGE FEE
OWNER'S PENIN s ] 00.
AUTHORIZATION TOTAL. FM rn REI
YBURBEYHNTfEE
1 RAVE AT THIS DATE A CONTRACT-WITH THE HEREIN NAMED CON- APnOVMS DATI? IN"EC19BLSSIVATURE,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLIX-G
TO THE PUBLIC SEyWER. NEN HOUSE SEWER
SIGNED THIS nAY OF 9 CONNECT ADDITIONAL
BUiLDIN-G OR WORK
OWNERS AGENT SEPTIC TANK,BEEP,PIT(S)
•A-DDR AND/OR DRAXFIEID
1 HEREBY ACKNOWLEDGE THAT I HAVE READ TH19 APPLICATION CESSPOOL[I DRYWELL❑
AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORpINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEVER OR
PLUMBING AND JEWE". SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AY PROPERLY REG13TEREb AND/OR DISCONNECTPLUG AND
LIQENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA bR THAT I AY THE GAL OWNER OF THE ABOVE ABA DON HOUSE"EF
DESCRIBED RESIDEXV FROPER BACKFILL SEPTIC N ❑.
SIGNATURE BEEP.PIT(3) ❑ CTAKS SPOOLS❑
OF PERNITI
JOHN A. LAMBIE, Co TY ENGINEER VALIDATION ROBERT A.WOOD, CHIFLF PLDG. IN.SPECTOR
■.o, "r'5It
3 9 5 2 FR. AU61 g ion
450 R
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