HomeMy Public PortalAbout5918 CAMELLIA AVE_Sewer__ APPLICATION FOR PERMIT 1
Pri-BION OF B=ING AMID SAFETY SEWER—SEWAGE DISPOSAL
mat of Cmo EnghMs
Commtt of Lo. Anvers D D ILD I V G
JOHN A. LAMBIE,COUNTY E:NgINaER ADDRESS
m CA,tHATT D.GRIFFIN, SUr T OF BUILDING LOCALITY
NEAREUT
FOR APPLICANT TO FELL IN CROSS ST.
LEGAL -��
DESCRIPTION LOT N0.
MAIL
BLOC[ TRACT S ADDRESS fU
KO. OF BLDG3. CITY TEL. NO.
SIZE OF LOT VOA OK LOT
USE
BUILDINGS DDISTRICT NO. GROUP WAP
BI PG
CONTRACTOR
ADDREaa ZCOHnEC.'TION DATA
2—f ki
S
CITY STATION 2. DEPTH
L '
TENO. R"HOLE RVM EkCslo ' OY
[C'TMTE
RISGIMATIOK NO. ❑ COUNTY f
No. DESCRLF'Tln OF WORK PEE
TYPL OF -ON�ECT] LENGTH FROM
HOUSE 11=CONNECTING TO Y. CUR P.L. M.L.TO P.L
PUBLIC SE7ER @ $3.30 O O
SEPTIC TANK,SEEPAGE FIT OR
PITS AND/0 DRAIKFIELD 3.00
OVERFLOf SEEPAGE PIT,DRAINFIELD P. C. no"
I
EXTN.,CESSPOOL,
DRYWELL MANHOLE 2.00 CO. IIP. V0. JOS KO.
HOUSE SEWS CONVECTING 0
PRIVATE DISPOSAL SYSTEM ® 31.00
TRUNK PERMIT NO. ROAD PERMIT K0.
CONNECT ADDITIONAL BL G.OR STATE"gROACHIENT
WORK TO HOUSE SEWER ;1.00 PERMIT V .
ALTER,RSPAIR OR ABANDON HOUSE
INDUSTRIAL
SEIYER OR DISPOSAL qYMIf 11.00
■ARTS APPROVAL
CHARGES
CONVECTION CHARGE FEE
OWNEg'S PMMT s 00
AUMOBIZATION TOTAL FEE 11 REIYBURSEYEKT FEE
1 HAYE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONN- - APPROVALS DATE INSPECTOR'$SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIAY CONVECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGE.' _ v SEPTIC TANK,SEEP,PIT($)
ADDRES AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR;SEWER OR
PLUYRING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY T}IAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY 63 ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I THELEG OWNER OF THE ABOVE ABANDON HOUSE SEINER
DESCRIBED RESIDENTIAL PERTY. BACKFILL SEPTIC TANKS❑
;IGNATURR
SEEP.PITS) ❑ CESSPOOLS❑
OF PERMI
JOHN A. LAMBIE. NTY ENGINEER ALIDATION ROBERT A.WOOD,CHI[F PL.BG. INHPSCTOR
CAM
LT 5 5 9 1 .9 OCT 8. 1 A 6.0 0 �