HomeMy Public PortalAbout6032 CAMELLIA AVE_Sewer__ 24650 INSERTS
CE8066.60 APPLICATION FOR PERMIT
76A842D COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEERBUILDING
BUILDING AND SAFETY DIVISION ADDRESS cl-3 a
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
iDESCRIPTION LOT NO. OWNER i
BLOCK TRACT MAIL
ADDRESS
NO.0 BLDGS.
SIZE OF LOT NOW ON LOT I CITY TEL. NO.
USE OFDI 1�� DISTRICT NO. GROU? MAP PROCESS BY
BUILDINGS /1
�
CONTRACTOR BK PGG
C
ADDRESS CONNECTION DRTA
CITY TEL.NO.Lcd,5� STATION I DEPTH /
�
/� STATE MANHOLE REFERENCE
f- !L
REGISTRATION N0. 9� COUNTY 0
. LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ .00 �1 TYPE OF CONNECTION LENGTH FROM � s
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ 32.00
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP.NO. O JOB NO, w
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. V
WORK TO HOUSE SEWER @ 31.00
SEWER OR PAIRO R ABANDON HOUSE @ $1 00 STATE ENCROACHMENT 03
PERMIT NO. F
INDUSTRIAL V
WASTE APPROVAL Pi
CHARGES rA
OWNERS PERMIT s 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVETHIS DATE A CONTRACT WITH THE HEREIN NMED CON-
TRACTORATO CONNECT THE ABOVE DESCRIBED EXISTINGA
ADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT �� BUILDING OR WORK
OF ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 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
1 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 L ROPERTY. BACKFILL SEPTIC TANKS Cl
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERMITTEE
OF VALIDATIOW__--� ROBERT A. WOOD
CK. M.0. CASH / SUPERVISING MECHANICAL ENGINEER
r
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 I SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE 0508 9702270008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 11
PHONE: (818) 285-0488 EXT:
LEGAL ID: SEWER SEPTIC: 9 — BUILDING
TR: 6561 LT: 154 EXIST OCC GRP: 16032 CAMELLIA AV:
BLDGS. NOW ON LOT: TEMP CA 917802007
ASSESSOR I CONNECTION TYPE: NEAREST CROSS STREET:
5385-018-021 ORIGINATION: THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE: LPPER/LOWER: ,
02/27/98
COUNTY IMPROVEMENT NLMBE;t: 02/2777 TC
06INER: TEL. NO: PLAN CHECK NUMBER: ,
MAESAKI TED•WAKAKO (818) 285-3962- JOB NUMBER:
6032 CAMEILfA AV TRUNK PERMIT NUBER:
TEP 917$02007 ROAD PERMIT NUMBER:
- - AFFADl1VIT: NO �� , �^ WORK t0 EXISTING }N011SE 89dER CONNECTION .
WAIVER: JIOAPPLICANT: TEL. NO: �J
NO
FRANK MARROINE N4 SOMI, INC. (818) 444 2548 EASEMENT: '
RECORD IN8TRUMBIT �-R FE•"' ,
HIGHWAY/9 W D 0 / �J
STATE ENCROACF4MJ T �R:
DATE INSPECT
CONTRACTOR: TEL. NO: OR SIGNATURE
FRANK MARRONE AND SONS, INC. (818) 444-2548- �-. aW
9860 LOWER AZUSA ROAD LIC. NO FEE DESCRIF _�To bog: Am ow lum
EL MOMTE, CA 91731 C16/ • -� L
ARCHITECT OR ENGINEER: :
15 ALT/REP 3(b'� BUILDING OR WORK
01 PERMIT I d` 5CONNECT ADDITIONAL
EVAGE PIT
LIC. NO: I TTTAOOT!!1LL AND/OR DRAIN FIELD
SEWER MAP BOOK: PAGE:
/ S REPAIR SEWER OR
DIiiO SYSTEM
ABANDON HOUSE SEWER
WXS�ILL SEPTIC TANKS
SEEP. PIT _ CESSPOOLGRAYWATER SYSTEM
_
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* ADDITIONAL DATA ON FILE
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REPORT ID: DPR266 ROUTE TO RSD508
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