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Home My Public Portal About6047 CAMELLIA AVE_Sewer__ 7eA e420-cEeoe-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ✓ ADDRESS LOCALITY KA R K 57 FOR APPLICANT TO FILL IN NO" n CS sT LROAL DESCRIPTION LOT NO. OWNER �S MAIL BLOCK TRACT ADDRESS NO. OF ■LDGB. SIZE OF LOT NOW ON LOT CITY TIL H0. USE OFD15TRICTNO. SROUP MAR CESDED DY BUILDINGS ■K PE CONTRACTOR f P / ADDRESS CONNECTION bATA CITY r !Jf T— NO. STATION DEPTH STA TI LIG MANHOLE RSF[R[NC[t'� ` ^� ! UPRR LICENSE NO�/.� C"Ss ._J .J /.2 �L. iYMBR NO. DESCRI IONWORK FIs TYPE OF c�p��"� ION LENGTH FROM HOUSE SEWER CONNECTING TO U Y. `rLU P.L M.L.TO P.L. PUBLIC SEWER $7.00 S PTIC TANK.SEEPAGE PI OR A / P.G.NO. PITS AND/OR DRAINFI ELI 610.00 CO.IMP. NO. U b JOS NO. HOUSE SEWER CONNCTING TO TRUNK PERMIT NO. ROD PER fT N "7 � PRIVATI E DI■POSAL■Y STEM ff.00 Ad O� O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT •YE[■ '[AlfYl[R RECORD.INSTR.NO. DAT[ V WORK TO HOUSE SEWER f3.0o OVERFLOW SEEPAOE PIT.DRAINFIELD EXTN..CESSFOO LDRYWELL 63.00 O ALTER.RKPAIR OR AM DO OUSE HWY.OR ST.WIDENING POfAL SYSTEM 67.0 SEWER OR DIR0 STATE ENCROACHMENT MANHOLE • 37.00 PERMIT NO. O. INDUSTRIAL y 1��7�L+ WASTE APPROVAL Z O Y[�ZE RiE2'S PERMrTi D 00- CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARD[F[[ I HAVE AT THIS DATE A CONTRACT WITH THE HER NAMED CON. REIMBURSEMENT FI[ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ArrnOVAJ.y TO THE PUBLIC SEWER. •AM DAT[ INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 1D_ OWNER OR NEW HOUSE SEWER y OWNERS AGENT CONNECT ADDITIONAL BU I LDI NO OR WORK ADDRESS SEPTIC TANK,S[EP,PIT(S) I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFI[LO AND STAT[ THAT THE ABOVE If CORRECT AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES AND STATI LAW/ REGULATIIIG PLUMBING AND SEW ERI. CESSPOOL ❑ DRYWELL ❑ I HERESY CERTIFY THAT I AM PROPERLY R[OIST[RED AHD/OR ALTER,REPAIR.SEWER OR CEA LIC S R[OUIR[D BY LO■ ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, TH[ ABO [ DESCRI R NTIAL P P[RTY. ABANDON HOUSE•[W[R SIGNATURE OF F[RMTTTEE BACKFILL/[P-�IC TANK/ ❑ ■[[F.PIT(B) LJ CESSPOOL./ VALIDATION C IA.0. CASH 639-FEB 810 U 1 0.00 76A 642D-CE606-10-71 )� APPLICATION FOR PERMIT COUNTY OR LOSANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIna ` CA � iV 4� ADDRESS LOCALITY FOR APPLICANT TO FILL IN N[ARErS CR �-JO Olf ■T. KOAL DCRIFTION LOT NO. OWNER [/ L+ � MAIL BLOCK TRACT ADDRW Y�jNO. OF BLDGS. ■IZ[ OF LOT NOW ON LOT CITY TIL. NO. USE OF BUILDING/ DISTRICT NO. SROUF MAP CE63E0 BY ■K PS /J CO NTMOTOR 'LJ �QA N /3 ADDRW �Z] V ill� 1 CONNECTION DATA f STATION /. DEPTH CITY T[L NO. ffTA:pi MANHOLE R[FERENC[ 5 � ! up LICENSE NO 'bC No. DESCRIPTION OP WORK FIE TYPE OF co ON LENGTH FROM yt HOUSE/EWER CONNECTING TO Y. R F.L. M.L TO P.L_ FU/LIC/EWER 0 $7.00 V SEPTIC TANK.SEEPAGE FIT OR O JOB NO. FIT/AND�OR DRAINFI CLD � f10.00 CO.IMP. NO. JOB NO. HOUSE /EWER CONN[CTInO TO TRUNK PERMIT NO. ROAD PERMIT NO�/!1�7O 0 PRIVATE DISPOSAL SYSTEM 93.00 7 CONNECT ADDITIONAL B .OR AFFIDAVIT •uV[■ "CORO.INSTR.NO. DATE u WORK TO HOUSE SEWER 53.00 OVERFLOW SEElAOE FIT.DRAINFI[LD EXTH..CESSPOOL.DRYW[LL S5.00 O ALTER.REPAIR / R AANDO O HWY.OR ST.WID[NINO I— ■EWKR OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT MANHOLE $7.00 PERMIT NO. D- N INDUSTRIAL Z �T�p WAITS APPROVAL O��}NER'S PERMT s 3 OD, CHARGES AOTHOBMTION TOTAL FEE Q CONNECTION CHARD[FI[ I HAVE AT THISDATE A CONTRACT WITH Tl-Ill HER NAMED CON. RIIMBURT FII SEMKN TRACTOR TO CON N[CT THE ABOVE D[1CRIBED [XIfTINO DWELLING AOVA� TO THE PBLUIC SEWER. DAT[ INBFECTOR'S SIGNATURE SIGNED THIS DAY OR IG_ OWNER OR NLW NOUS[/EWER r �• 1 t X I I OWNERS AGENT CONNECT ADDITIONAL ■UILDINO OR WORK ADDRESS BEPTIC TANK.BEEF.PIT(6) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIRLD AND STAT[ THAT TH[ ABP ABOVE 19 CORRECT AND AGREE TO COM LV WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING CEJ/FOOL ElDRYW ELL ElPLUM/IND AND SEWERS. IHEREBY CERTIFY THAT I AM PROPERLY REGI6T FRED AND/Opt E ALTER.REPAIR.SEWA OR L IC EN BED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISFO■AL SYSTEM CALIFORNIA OR THAT I AM T E LEGA OW HER OF. ND INTEND TO DISCONNECT PLUG AND RESIDE In. THE A■OV[ D DEL BEID[NTIAL ROFERTY. ABANDON HOUBK SEWER BIONATURE ❑ OF P[RMfTTII BACKFILL fEPTI NKl ■[[F.PIT( FOOLS VALIDATION CX M.O. CASH 6 4 O P FEB 8 1 0 D 1 0.0 0 a___8 IZ-0° T°A e42D APPLICATION- FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY HNGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGIN[[R A-- ' COLEMAN W. JENKINS. SUPT, Or BUILDING lr LOCALfTY NEAREST LEGAL NT FOR APPUCATO M IN CROSS ST. DESCRIPTION LOT NO. OWNER Aj MAIL BLOCK TRACT ADDRESS N . OF BLD". SIZE OF LOT ON LOT CITY TIL. NO. USE OF T11 DIf1CT NO] O GROUP Bx MAP BY BUILDINGS _ CONTRACTOR D ADDRESS d- CORRECTION DATA --.L� CITY STATION Dwr,TIL. N O. LICENSE N �� tILASS MANHOLE REFERENl CE L��LIO�� NO. DESCRIPTION OF P WORK FEE TYPE OF CONNECTION`•/ �7 �� LXX OTH FROM ' HOUSE SEWER CONNECTI Na TO O Y. CURB P. Y.L.To P. PU SLIC SEWER a $5.00 P.C.NO. SEPTIC TANK.9431PAmE FIT 09t JOB NO. PITY AND/OR DRAINFIELD 510.00 CO.IMF.NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD r[RHIT PRIVATE DISPOSAL SYSTEM 47.00 p CONNECT ADDITIONAL SLOG.OR AFFIDAVIT I SYv[.I [u/ KT RECON.INSTR.NO. DATE U WORK TO HOUSE SEW" moo C= OVERFLOW■"PAG[PIT.DRAINFI[LD O E)CTN..CIL"P,COL.DRYWELL.MAfyHOL[ $5.00 ALTER.PIIILPARO A NDO O HWY.OR ST.WIDENING V BEWER OR DISPOSAL SYSTEM 7.00 STATE[NCR OACHMENeL T PERMIT NO. INDUSTRIAL WASTE APPROVAL O n EPs PERMIT 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION I TOTAL. FEE 0106 I HAV[ AT THIS DATE A LONTRACT WITH THE HEREIN NAI D CON- REIMBURSEMENT FE[ TRACTOR TOL.CONNECT THE ABOVE DESCAIBED LXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'ip SIGNATURE SIGNED THIS DAY OF 1D_ OWNER OR NEW HOUSE SEW" OWNERS AGMKT CONNECT ADDITIONAL ADDRESS WILDING OR WORK I HEREBY ACKNOWL[DOE THAT,1 HAVE E RAD THIS APPLICATION SEPTIC TANK. FITS) AND STAT[ THAT THE ABOVE If CORRECT AND AGR[[ TO COMPLY AND/OR DRAINFIEI[LD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING FLUMBINO AND °EWERS. CESSPOOL ❑ DRY-WELL ❑ - 1� I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR LICENSED AS REQUIRED BY LOG ANGLES COU AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE VE D IDETITI FROP[RTY. ABANDON HOUSE SEWER SIGNATUREn OF P[RYTITQ BACKFILL BK µ1C TANKS 1-i BEEP.PIT fS) LJ C[SSFOOL,f VALIDATION JACK R. ALLEN f'�Clc. M.o, CASH 61U/P�E_RV1{81aNG MECHANICAL WGINEHR Y `�`- 6 4-!I,,--M 8 1 0 1 0.0 0 e