HomeMy Public PortalAbout5920 CAMELLIA AVE_Sewer__ a
APPLICATION FOR PERMIT 7
DrVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL 1
D%-rW=nt of Coantt HaQh~
Co=iT d'Los Angsam BUILDIRG
JOHN A. LAMBIE, COUNTY ENGINFEER ADDRESS
T CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FELL IN CROSS SST.
LEGAL
DESCRIPTION LOT No. Ig OWNIER j
MAIL )y
BLOCK TRACT ADDRESS a
1 NO. OF BLDGS. C1TY •TEL.M0.
SIZE OF LOT 4 NOW ON LOT
USE
BUILDING!DDISTRICT No. GROUPYAP
�+ BK PG
CONTRACTOR
ADDRESS Q a CONNECTION DATA
STATION DEPTH
CITY Ab Trj-. No. O
MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRATION R0. O ❑ COUNTY
NO. DESCRIPTION OF WORK FgH
TYPE OF COXXE ION LEN OY
OUSE FEWER CORRECTING TO Y. CURB P.L.
i PUBLIC SEWER ;S.SO
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD • a 4 9.00
OVERFLOW SgEPAGE PIT,D INFIELD C0.'IYP. X0, JOB N O
i El(TN.,CESS OL,DRYWELL MANHOLE 2.00
1 HOUSE SEDER CONNECTING TO '
i PRIVATE PISPOSAL SYM ' ;1.00 TRUNK PERMIT NO. OAD PERMIT RO.
NNECT ADQITIOXAL BLDG.OR - STATE EXCROACHYE
WORK TO HOUSE $1.00 PERMIT N0.
ALTER,R HOUSE
INDUSTRIAL
SEVER 0 1 POS 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OV NER'SPERMIT s 1 00 REII6URSEY�Xr.FEE
AUTHORIZATION TOTAL FEE p
I HAVE AT THISDATE A CONTRACT WITH THE HEREIN RAYED COX- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DOCRIBED (XjITINq DW F"
TO THE PUBL4C SEWER. NEW HOUSE SEINER
SIGNED THIS nAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORD(
OWNERS AGP.KT SHPTICTANK,SEEP,PIT($)
ADDRESI• AAD/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
PLU-"IXG AND SEWERS. I AGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AYPROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORMIA OR THAT I AM THE LEG L OWNER OF THE ABOVE ABANDON HOUSE 8EIV
DESCRIBED'RESID`EN Al OPER BACKFILL SEPTIC TANKS❑ �•
SIGNATURE SEEP.PIT(S) ❑ CESSPOOL$
OF PERM17TER
.JOHN A. LAM13IE, COUNTY ENGINEER AlMATION ROBERT A.WOOD, CHIKF PLBG. INGFECTOR
M.0. we
L0 3 3 4.9 ,Ail.3 0 10 A 2.0 0 :