HomeMy Public PortalAbout5738 CAMELLIA AVE_Sewer__ ,9A44Ab
•a aeaa u-dd APPLICATION FOR PERMIT 1
DIVISION OF 1 =ING AND SAFETY SEWER—SEWAGE DISPOSAL
D.po>bu.nt Of Corr Enubmew
C--3it of IA- Angel- FADDRM
DING
JOHN A. LAMBIE, COUNTY ENQINEdat
CAb.6ATTD. GRIP-FIN, SUF"TofRUfLDINO WTY
IqF
FOR APPLICANT TO FILL IN CR"''T
LEGAL
DESCRIPTION LOT N0, •/ 01NIER /
BLOCK TRACT PAIL
ADDRESS
NO.OF BLD GS. CITY
SIZE OF L07 NOW ON LOT
USE OF 0. DI>O. GROUP MAPP
BUILDINGS
K
CONTRACTOR /
ADDRESS
Z CONK= nATA
/TATIO DEPTH
CITY THL NO. 147147119
YANHOLII CH
STATE OW
REGISTRA n N0. O K COUNTY
No. DESCRIPTION OF WORE( FEE
HOUSH SEWER CONNECTING TO TYPE
OF ION LENGTH FRO■
UBLIC SEWER @ Y• URB. P.L. Y.L.TO P.L.
SEPTIC TANK,SEEPAGE.PIT OR
PITS AND/OR DRAINFIELD ® ;3.00 !!((
OVERFLOW SEEPAGEPIT,DRAINFIELD CO. IMP. N0. .JOB N6�
ExTX.,CE3C.
SPOOL,DR E L MANHOLE ;2.00
HOUSE SEWER CO NECTING TO
PRIVATE DISFASASYSTEM 1.00 TRUNK PERMIT NO- ROAD P IT NO.
CONNECT A I AL LD ,OR STATE ENCROACHMENT
ORK TO ;I.Po PERMIT NO.
ALTER,REPW OR ABANDON"USE-' INDUgTRIAL
SEWER OR DISPOSAL B EY @ 1.00 wAdTC APPROVAL
CHARGES
CONNECTION CHARGE F"
OWNE$"S PE WT o0
REIMBURBEME1fT FEE "
AUTHORM&TION I TOTAL FEE T�
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COX- APP OVAJ.s D E IMS-P8 OR-89IGNATURE
TRACTESC
TO CONNECT THE ABOVE DRIBEb EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THI AY OF I CQNNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT BEANK,SEEP,PIT13)
ADDR16k- ANpTIC TD/ R DRAIXFIELD -
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY -
WITHALL COUNTY OkDINAXCES AND -STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROP EGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED Y LOS ANGELES OUNTY AqD STATE OF
CALIFORNIA OR TW AN T A OW ER HE ABOVE ABANDON HO SESEWML
DESCRIBED REQIbEN PROP BACKFILLSEPTIC TANKS
SIGNATURE EE
SP•PIT(3) [1CESSP0
QF0. o
OF PERM
JOHN A. L-AMBI LINTY ENGINEIER vAubATION ROBEFZT.A. WOOD, CHIaa PL.ba. INSPECTOR
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