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Home My Public Portal About6018 CAMELLIA AVE_Sewer__ C6° o In APPLICATION FOR PERMIT CQVNTT OF LOS ANGKIM SEWER-SEWAGE O SPOSAL � DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ■uILDIN or • JOHN JL T i1YBM CintimtvEnahLow (DDR[Y WMUAM JL T MMEN, Dap'[ OID,flcUnq (,OCA L TTY MXARErT FOR APPIWANT TO FILL IN "°°' ■T DESCRIPTION LOT NO. OWNKR MAIL BLOCK TRACT ADDRESS NO. OF BLD GI. SYZ[ OF LOT 11LW ON L CfTY TEL NCO. Uall BUILDINGS OF DISTRICT NO O UP YAP PROCESSED BY gVI ■K PO CONTRALTO AyDRW / ONNECHON DATA CITY T1SL. NO, / D STATION DEPTH Itla BATIK MANHOLE REFEII[NC[ UPPER REGISTRATION NO. erR COUNTY LOVhM NO. DESCRIPTION OF WORK TMP[OF CONNECTION- LENGTH FROM Wr H0VSE SEER CGONN ECTI TO YP . CURE L. Y.L.TO P.L V PUBLIC[[WEA $19.00 P.C.NO. d SEPTIC TANK,BEEPAG[PIT ORGO.IMF.NO. JOB No. PITS AND/OR DRAINFIELD !10.00 HOU■[SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM $9.00 CONNECT ADDITIONAL BLDG.OR ! A"IDAVIT •Anr>t LAX[ RECORD.INSTR.NO. DATE N WORK TO ROUSE SEWER $9.00 OVRFLOW SEEPAOE PIT,DRAINFI[LD L EATN.,CESSPOOLDFTYW[LL MA NH OLE@ $19.00 AL /SIR R A N HO ■ HWY.OR ST.WIDENING ■[W[R OR DISPOAAL SYSTEM 41 43.00 STATE ENCROACHMENT PERMIT NO. YNDUff"IAL WASTE APNROVAL OWNEE'S PEncT $ 21 00 G n CONNECTION CHA E FEE AUTHOETLATION TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT N CT WITTH[ HEREIN AMm CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED p(ISTING DWIII.LING TO THE PUBLIC SEW[". OVAIS DATE INSPECTOR'S SIGNATURE SIGNED THIS . DAY OF ID_ OWN"OR NEW HOUSE SEWER OWNERS AURNT CONNECT ADDITIONAL - BUILDING OR WORK ADDRESS SEPTIC TANK,BEEF,FIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL APPLICATION AND/OR DRAINFIED AND STATE THAT THE ABOVE IE CORRECT AND .-,GREE TO COMPLY WITH ALL COUNTY OFIDINANC[Y AND -bTATE LAWS REGULATING PLUMBING ANSEWERS. CESSPOOL Q DRYWELL ElD I HKPM19Y CRTIFY THAT I AM PROPERLY 141901 ST R[D AMP/OR ALTER,REPAIR,S[WISR OR L IG[NSED Af R[GUIRED ■Y LOS AHGLEI COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO gBAND N H PLUG AND nnloE IN, TH[ A Dd IB[D Rnl A PROP[ ABANDON ROUE[SEWER SIGNATURE BACKFILL SLITic TANKS ❑ OF PERYI SEEP.PIT(E) ❑ CESSPOOLA VALIDATION ROBERT WOOp y cK. ,o. SEH BUPERW8ING MECHANICAL ENGINEER X329560 JUL 11 0 D 500- c °4 76Abi2 APPLICATION FOR PERMI AU213` , COUNTT OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL U B=ING An SAFETY DIVISION BUILDING OH2t X. L' •� ADDRESS JLC 8nP'E F-of ��ld�q LOCA L fTYAll N EA R EST FADDRIL" R APPLICANT TO FILL IN CROSS ST. LROAL LOT NO. OWNER MAIL O BLOC71 K TRACT ADDRW NO. QF NOW ON L CTI' N O. DISTRICT NO. dRDU AP PROCE"Lp■Y 'BUILDINGS f ■ PG COM(ECTION ATA CI'h' TEL. NO. STATION DEPTH STATE MANHOLE RIFERINC'[ UFPtR REGISTRATION NO. COUNTY LOWER NO. DESCRIPTION OF WORK FI[ TYPE OF CONNECTION LENGTH FROM E HOUSE SEWER CONNECTING TO Y. CUR■ P.L N•L.TO P.L. PU■LIC •8.00 ■[DTIC P.G.NO. TAH ■ PA E P I C. PITS AND/OR D1IAINF[LD X10.00 CO.IMP.NO, JOS.NO, a H OUA SEWER CONNECTING TO TRUNK PkRM1T NO. ROAD PERMIT NO_ O PRIVATE DISPOSAL SYSTEM $2.00 CONNECT ADDITIONAL IsLbo.OR AFFIDAVIT /AfRB r..[SQT RECORD.IN■TR.NO. DATI GL WORK TO MOUS[SEWER •9.00 Q OVERFLOW SEEPAGE PIT,DRAINFI[LD r [XTN.,C[■SFOOL,DRYWELL.,MANHOLE 0 $5.00 IVL A DOO HWY. OR/T_WIDSNINO d S[w[R SYSTEM 9.00 STAT[ENCROACHM[HT P[RMITHO. _ INDUSTRIAL ��p• WAST[APPRDYAL O��n NLLi S PELT 2 00 C ARMLS CONNECTION CHARGE FEE AOTHORM3MON TOTAL FEE 'I HAVE AT THIS,DATE A CONTRACT WITH THE HEREIN NAME CQN• REIMBURSIM[NT FEE TRACTOR TO CONNECT THE ASOVI D[SCRHSED uISTING DWELLING �l TO THE PU ELIC • 1: O♦ DATE INSPECTOR'S SIQNATURE SIGNED THIS Y OF Iq OWNER OR NEW HOU■ER OWNERS A13 CONNECTADDITIONAL I BUILDING OR WORK ADDRlJS14 SEPTIC TANK.SEIP,PITS) 1 HEREBY ACKNOD WLEGE THAT I A PPL READ THIS APPLICATION AND/OR DRAINFIRD AND STAT[ THAT THE ABOVE IN CORRECT AND AGR[[ TO COMPLY H WITALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL DRYW[LL [3FLU MBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERE LY REGISTRED AND/OR ALTEE R,REPAIR,■ w ER OR LIC[NE[D AS REQUIRED BY 402 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYST[M CA LI FORMA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RdID[ IN, THE A■ [ D[SC IB[D REPEI11 BID NTIA ROPRTY. ASANDON HOUSE SEW YIOF PKIR[ BACKFILL■E IC TANKS ❑ OF [RMITT[E SILT,PIT(S) CEbFQOLI VALIDATIO ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CATH LACo l 9 8 510 MAY 2 5 1 0 0 5,0 0 _ D>IEPAWnflo+NT OF COUNTY ENGINB SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAF= PERMIT APPLICATION OOUNTY OF LOS ANGEI, WILLIAM J. FOX, CouwrY EHOIIH[ER BUILDING ADDRESS Q FOR APPLICANT TO RLL IN LOCALITY BUILDINGCO f /lA NEAREST ADDRESS f� CROSS ST. LOCALITY / DISTRICT NO. SERIAL M0.VV /f f (/-PERMIT M0. NEAREST A L /-0 / S GROSS ST. OM& Rn�for lupbli�■ DAT[ISSUED OWNER _ -2 MAIL USfi ZONfi OOCiUPAMCY YAP ADDRESS ` /`rf)[�f BK PB CITY TE 0. _ / ; / CONTRACTOR CO.IMP.N0. Q C ADDRESS �'�"� JOB NO. TELLMO. TRUNK PERMIT NO. STATE REQIST IOM NO. U OOUMTY ROAD PERMIT M0. LEGAL STATE ENOROACHMENT DESCRIPTION LOT NA PERMIT M0. BLQOK TRACT /' INDUSTRIAL WASTE APPROVAL SIZE OF LOT 4 0.OF BLDG&. NOW ON LOT CHARGE USE OF BUILDINGS CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE OUSE SEWER CONNECTING TO PUBLIOSEWER O 3ZS RECEIPT NO. TE riy HOUSE SE M IM 0 PRIVATE DISPOSAL SYSTEM Im CONNECT ADDITIONAL OR EXCEPTIOECORDED WORK TO HOUSE SEWER 1.00 ALTER R R A Q NO ATE BY SEWER OR DISPOSAL SYSTEM 1.00 DI&00MNEtT AND ABAM M SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA WP,TIOTANk' S 8 R PITS AMB OR DRAIMFIELD 2-W STATIOIIF DEPTH PO L L SPECIAL CONDITIONS ONLY 2-00 . MANHOLE REFEREMOE - LOWER PE OF OONNE�}.GN LENGTH FROM OWNERS PEWfT $ 1 00 CURB M.L TO P.L S AUTHORIZATION TOTAL FEE Q , ' I HAVE THIS DAT[ CONTRACTED WITH THE HER IM NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS IMSPECTO"SIGNATURE DATE DWELLING TO THE PUBLIO SEWER SIGNED THISDAY OF I NEW HOUSE SEWER OWNER OR F CONNECT ADDITIONAL �� /,� OWNERS AGENT r ��''� y� '� 1 BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(&) AND/OR DRA MFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E) ORYWELL CATIONAMD STATE THAT THE ABOVE IS CORRECT AND AGREE TO 00MPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAID SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT I AMED AMD/OR LICENSED AS REQ IRED BYPLOSP ERtY ANGE ESSICOURNTY DISWMNEOT PLUQ AND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER ER OF THE A13OVE ESCQIBED NTIAL PROP[QTY. IC TA SIGNATURE SE[r.PIT(S)E] OE&SP00 p- r� OFPERM TEAUTA 6Q3 T/53 r