HomeMy Public PortalAbout5803 CAMELLIA AVE_Sewer__ CLAOB'_°'
7eAS4ED APPLICATION FOR PERMIT
,
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION ■u LDING
OHM ft T✓U� - (-= ;r fa [[[ ADDRW��
iL ISI. 8IIP i Of >ZM. LOCALITY
NXARKAT
FOR APPLICANT TO FILL IN =Roes aTLlEdAL .
DESCRIPTION LOT NO. OWNER
MAIL
CLOCK TRACT ADDRESS
Ng. OP RLDUS.
SIZE bF LOT NOW ON LOT Y CITY TEL NO.
UI OP27e - DI RIOT NO. GROUP MAP P OC EYBED BY
SUILDINOS
�/ C/• BK PO/.
CONTRACTOR L� 4,,0,j. �. �J/ D 3 `•`/U
ADDREEB/3Q��� �,� CONNECTION DATA
r STATION / +S D[PTFi
`. NO.
R[QI'-(RATION NO. ���6ORK OAUMS, MAN HOP[REFERENCE OWER
No. 0E.SCRI-PTION OF V1lORFC FEE TYPE OF c Ion Lri�aTH rrROY
HOUSE BEWER CONNECTING TO _ Y• URe P.t M.L.TO P.L.
PUBLIC SEWER $5.00
P_C_NO.
SEPTIC TANK, A0Er OR CO.IMP.NO. -oS NO•
PITS AND/OR DRAINFI[LD *10.00
HOUBE SEWER CONN CTINMTO
PRIVATE DISPOSAL SY�PEM $3.00 'Rtt1NK PERMIT NO. ROAD PtJIJI IT NO
CONNECT ADDITIONAL■ .OR AFFIDA" WA"z u "KWT RECORD.INSTR.NO. DA TIL
WORK TO HOUSE SEW" X7.00
OVERFLOW■[[PAG[PR,DRAINFI[LD
[J(TN.,CESBPB O L.DRYWILL,MANHOLX 0 48.00
ALTER.R A R A DO O
HWY.ORST.WIDENING
8I WER OFL DIBPOSAL SYSTEM 3.00 STATE ENCROAC M
INY
PERMff NO.
INDUSTRfAL
WASTE APPROVAL
O ♦g PERMIT It z 00 CHARGES
AUTHOF=TION YOTAL FEF G COn N[C710N CHARGE FEL
I HAVE AT THIN DATE A CONTki WITH THE HEREIN NAMED CbN- REIFfItURJEMENT FEE
TRACTOR TO CONNECT THE ABOVE DES;:RIS[D EXITING DWELLING
TO THE PUBLIC SEW APPROVALS NSP[CTOWN SIO . [
SIGNED D OR L�I��/� 'p�
QYVN['fI Of 71
NEW HOUSE WWW R
OW ri[!{1 AO[NT6 CONNECT APDII`IONAL --
ADD RES* eut LDlnG OR WbRK
QMPTIC TANK,SEEP,PIT(S)
I
HEREBY ACKNOWL[D THAT I HAYX READ THIS APPLICA ION AND/OR DRAI NPIELb
Ai1D STAT[ THAT TH[ ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINAN CEJ AND STATS LAWS REGULATING POOL [I DRYW[L.L El
MB
INQ AND SEWERS. CFS*
f HRRESY CERTIFY THAT I AM FROPERLY REGISTERED AHD/OR ALTER.REPAIR,&*WiFt OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF
SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT TH[ L[OAL OF, AND INTEIfD TO DISCONNECT PLUG AND [
''REBID[ IN.
THE
A [SCRIBED W PROPERTY. ARAN BON HOUSE SEWER
eIOFA�YI BACKFILL SKFhIC TANKS Q
TTS ■[[P,FIT(e) EJ cE*aroou
,VAI. . r]CASH ENGINEER
ROME A. D
-.0
SUPERVISING MECHANICAL
CK. Y.O.
LIC03432'l-0 a?R171 0 a 7.00
r
CESOSa-e:
7e.Ae4[b APPLICATION FOR PERMIT
COUNTY
Tb= of LOS TY E GI SEWER—SEWAGE DISPOSAL
DEPlRTb�N'I' OF COUNTY ENGINEER
BUILDING AND SAFETY DrWSION ■uAD=
DINb
JOHN JL LADOIE _-R SO
�I WM A. �
.I , Sup'l of �Q
LO CA L rfY
NEAREST
FOR APPLICANT TO FELL IN CROSS ST.
DESCRIPTION LOT NO. pyyry ER
MArL
BLOCK TRACT / ADDRtS5
NO. OF SLOGS.
BIZ[ OF LOT NOW ON LOT CITY TEL NO_
USE OF
BUILDINFLS DISTRICT NO GROUP I MAP m SY
eK. FG
CONTRACTOR
ADDRESSee_ CONNECTION DATA
CI[TATI ON DEPTY
TIL ry
REGISTRATION Nb. �4fT' COUt�i"fY MANHOLE R[P[116NC[ LOWkR
No. DESCRIPTION OP WORK FE[ TYPE OF CONNECTION 0TT7Fl1oM
HOUSE SEWER CONNECTING TO Y. CURB P.L O F.L,
PUSLIC SE'W[R 0 •8.00 P.C.HO.
SEPTIC p.NK.SE[PAG[FIT OA CO.IMI JOS NO,
PIIS AND�OR DRAIN FIELD 0 510.00
HOUSE SEWER CONNECTINQ TO (J FERMIS NO.
PRIVATE DISPOBAL EIYSTEM 0 $3.00
CONNRCT ADDITIONAL OR O AFFHDA fATm [ XI T R=CORD.IHSTR.NO. DAT[
WORK TO HOUSE SEWN 0 13.00
OVERFLOW SEEPAGE FIT,DRAINFIELD
EXTN..CEIBPOOLDRYWELLMAHH041[It $5.00
ALTER.REPAIR ORABA DO OUSE HWY.OR ST.WIDKNIH0
SEWER OR DISPOSAL SYSTIM 3.00 BTALTICENCROACHMENT
PERMIT H¢.
INPUSTRIAL
O
--APPROVAL
OWNER'S PERMIT2 00 CHARDEs
AMHOETLATION TOTAL FEE CONNECTION CHA Fl([
I -HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REI MBU ENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBMP LXISTING DWELLING O AL�
TO THE PUSLIC SEWER, DATL HSP[CTOR' IGNA
SIGNED THIS DAY OF 1a
OWNER OR NEW HOUSE SEWER
OWNERS AGSM CDNNECT ADDITIONAL
ADDRL■
BUILD]NQ OR WORK
S[Ff IC TANK,SEEP,FrT(S)
I H"KBY ACKNOWLEDGE THAT I NAVE READ THI■ APPLICATION AND/OR DRAINFIrLD AND
STAT[ THAT THE ABOVE I■ CORRECT AND AGREE TO COMPLY
WITH. ALL COUNTY 0RDINAN CEf ANb STAT[ LAWS "GULATING
PLU We ING AND SEW[RS. CESSPOOL ElWr�DRY [LL 4-1
I t1EM[BY r[RTIFY THAT I AM PROPERLY J![GISTkR[D AND/OR ALTER,REPAIR.SEWER OR
LICENb ED AS REOUIRIP pY LOS "GLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
C,A LIFORNIA OR THAT I YH[ LEGAL O ANP IHT[ND TO pISCONN[CT PLUG AND
REST D[ UV, THE ASO D RISER I ROP[RTY. ASANPON HOUSE SEWER
■HOF PKRMTTr[E BACKFILL S[P[J_C'BANKS ❑
■[Q.FIT(S) u C[56FOOLS
VAMATIO ROBERT A. WOOD
CK. Y.O.
SUPERVISING MEC,HANICA� ENGPNEER
CATH -I
Lf U 3 U 3� h?l 2 5 1 0 D�
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