HomeMy Public PortalAbout5926 CAMELLIA AVE_Sewer__ E808.D
C 8.58 APPLICATION FOR PERMIT
E808. 7
COUNTY OF LOS ANGELES SEWER-SEWAGE DISP SAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL /
DESCRIPTION LOT NO. I-14 OWNER
BLOCK TRACT - �., MAIL
C' ADDRESS
NO.OF BLDGS.
SIZE OF LOT.�e :�, r' NOW ON LOT I CITY TEL.NO.
USE OF
BUILDINGS DISTRICT NO.1 GROUP BK P6 MAP PROCESS BY
CONTRACTOR .'�,e,e'�.. � �y �•
ADDRESS / e,J/ S , R_. CO ECT ON nATA
CITY _ , DEPTH. .
STATE
REGISTRATION N0. ® COUNTY MANHOLE REFERENCE PER,
_
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO $g•00 �[s
PUBLIC SEWER
TYPE OF CONNECTION LENGTH FROW
PETS AND//OR DRAINFIELD T OR @ $g 00 Y. CURB P.L X.L.TO P.L. /-4,7/
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE 0 $2.00 �-'L.
HOUSE SEWER CONNECTING TO /]P.-t.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP,N0. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER a $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE CROACHMENT
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT
INDUSTRIAL
WASTE APPROVAL ,
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE $�j REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT G BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT P OPERTY. BACKFILL SEPTIC TANKS 11SIGNATURE SEEP.PIT(S) 11 CESSPOOLS
El
OF PERMITTE !
�aVALMATION ROBERT A.WOOD
N.p, aectC SUPERVISING MECHANICAL ENGINEER
0 9 4Z33 NOV 3 0 1 5.0 0
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
77
FOR APPLI�NT TO ILL IN , LOCALITY �r
BUILDING NEAREST
ADDRES ( CROSS ST. }
LOCALI
DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST .__�` ` A a� `'--
CROSS ST
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER -
MAIL USE ZONE OCCUPANCY MAP
ADORES I BK PG
CITY L.NO. --
CONTRACTO
CO.IMP.NO.
ADDRESS (i" JOB.NO.
CITY TEL.NO. TRUNK PERMIT NO.
✓�f�j/.S ❑ STATE
REGISTRATION NO. r Z� ZiE ❑ COUNTY ROAD PERMIT NO. ---
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
�yy PERMIT NO.
BLOCK TRACT �� WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.�N �
NOW ON LOT��" �'� = CHARGES
USE OF
BUILDINGS /r- CONNECTI?111•C�ARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. ATE ` _,_�BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
—SEPTIC TANK,SEEPAGE PIT OR ,
PITS AND/OR DRAINFIELD 2.00 STATION 1-74- ! DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; I 00
Y. _ -GUA$ , P.L. %" M.L.TO P.L.
I - � `
AUTHORIZATION TOTAL FEE -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS------------•---•---DAY OF........................................19.------ NEW HOUSE SEWER_
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT- ----------_---------------------- BUILDING OR WORK
---------------------------------•------
SEPTIC TANK,SEEP.PIT(S)
ADDRESS............... ........... - .......................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL 0
CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS
SIGNATURE i/ jAC/r /�r(`!�•Y' -fE+i�
OF PERMITTEE _ ► -
76A642D 663 1/53