HomeMy Public PortalAbout5822 CAMELLIA AVE_Sewer__ APPLICATION FOR PERMIT. 1
I)PASION OF $UII DING AND SAFETY SEWER—SEWAGE D I S POSA L
Depo2w-nt of Cour Enghmw
Cooatr of Los ugel" BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CAEHATT Q. GRIFFIN, Sup-'T or BUILDIPIR LOCALITY
EAREST
FOR APPLICANT TO FILL IN CROST.
LEGALOWNER
DESCRIPTIO LOT No. 11
MAIL
BLOCK 1 TRACT]] /!T ADDRESS0. OF
SIZE OF LOT d !• Now ONBLOTa CITY TSL. NO.
USE
OF \ DISTRICT ROUP YAP
BUILDIMGS
BK PG
CONTRACTOR '* Z
ADDRESS49'3 ! r" / T`— STATION CONNECTION DATA
CITY TEL 110.,'4, �Lr(�O - DEPTH
MANHOLE REF'EREXCE _ -
Oil ❑ STATE LOWS
RHGISTRATION NO. ❑ COUNTY
No. DESCRIPTION OF WORK FEE z
HOUSE SHR HR CONNECTING TO TYPE OF CONNECTION LENGTH FRO f
.L Y.L.TO P.L
PUBLIC SEWER 1.70 -
SEPTIC TANK,SEEPAGE PR OR
PIT$AND/OR DRAINFIEL.D 3.00
OVERFLOW SEEPAGE PIT,DRAIN MELD 13 P. C. N0.
EITX.,CESSPOOL DRYWE L MANHOLE 2.00 CO. IMP. N0. O JOB N0.
HO BE SEWER CONNECTING TO '
PR VATS DISPOSAL SYSTEM @ j 1.00 TRUK ERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATS EklQROACHMEXT
WORK TO HOUSE SEWER ® 1.00 PERMIT X -
ALTER,REPAIROR ABANDON HOUSE INDUSTRIAL
SEWER OR DISP SAL SATEM 11.00 WASTE APPROVAL -
a ES
CONNECTIONGE FEE
OM ERAS i'mmrT s 1 00
REIMBUIXEMENTFEE
AUTHORIZATION TOTAL FFA
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COX, APLS PROVADATE IXSP OR'SSI ATURE
TRACTOR TO CONNECT T E ABOVE DE CRIDED UIS-TING DWELLING
TO THE PUSLI 8 NEW HOUSE SEWER
SIGNED THI AY 0 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK -
OWNERS AG SEPTIC TANK,SEEP,PIT(S)
ADD AND/OR DRAINFIELD
I HEREBT ACKNOWLEDGE THAT I HAVE READ THIS APPLICAT N kOL❑ DRY*ELL ElAND /TATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINARCES AND STATE LAWS REGULATING , PAIR,SEWER OR
PLUMBING AND SEWERS. 3EWAGEREDIDPODAL JYSTEM
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CGOUNTY AND STATS OF ABANDON HOUSE BE
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF TI(E ABOYE
DESCRIBED RESIDENT L ROPERTY. BACKFILLSEP_TIC TANKS ElSIGNATURE
/ SEEP.PIT(9) CESSPOOL!
OF PEYMITTKE -
JOHN A. LAMBIE,COUNTY ENGINEER VAI,IDA7I0N_� ROBERT A.WOOD,CHI my PLBa. INSP[CTOR
C><. IL a .
LAP,5022En FSBl1 4 450