HomeMy Public PortalAbout6052 CAMELLIA AVE_Sewer__ :�;1f-" APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dopatn.nt of Cour F"bbs.r
County of Los Anaelm BUILDING 6
JOHN A. LAMBIE, CouNTY ENGINEER ADDRESS
CJkBSAR D. GRIFFIN, Sur-r of CIjILDING LOCALITY B c. �/ T+
FOR APPLICANT TO IN cRos
DHSCR L ON LOT NO. OWNER WIG T RSoa
MAIL )
BLOCK TRA�C/T• fp ✓ ADDRE3/ �.{/SLAC STOa OyI p
3IZT OF LOT O ^ NOW-OR LLOTB.. CITY INV TEL. NO. � %Z/ 9
USE
OF I DIST72 MAP
BUILDS 83
BK PG
CONTRACTOR
ADDREn may, CONNECTION DATA
STATION 1 DEPTH
CITY TEL N0. MANHOLE REFERENCE UPPER
❑ STATE
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYP OF ON LENGTH FROM
P.L. Y.L.TO P.L.
PUBLIC SEWER 3.110
T. CURB
SEPTIC TANK.-SEEPAGE PIT OR
PITS AND/OR DRAINFIKLD 0 3.00
OMFLOW SEEPAGE PIT INFIELD PO C.
DRYAHL .EKTN. CESBPOOL LL,MQO CO. IVP.NO. O..
HOUSE SEWER COM kkCTIXa TO
PRIVATE DISPOSAL SYSTEM @ f 1,00 TRUNK PERMIT jqq. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT _
WORT TO HOUSE SE7WFR 0 S 1.00 PERMIT NO.
ALTER,WA1R OR ABANDON HOUSE
SEVER OR DISPOSAL SYSTEM 0 1.00 INDUSTRIAL SEVER APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS FEW" ; 1 00 I!
AUTHORIZATION TOTAL FEE REIMBURSEMENT nM n W#OVSG —1* 016 MP
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COX- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED UI
STING DWE"I"
TO THE PUBLIC B NEW HOUSE SEWER L9 S-k
SIGNED THIS 3 n Y OF SB l9 L CONNECT ADDMORAL
OWNER OR ` BUILDING OR WORK
OWNERS AGTIIT ' SEPTIC TANK,3EEP,FIT(3)
ADD AND/OR DRAINFIEL.D
I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION CESSPOOL ElDRYWTLL El '
AMD STATE THAT THE ABOVE 13 CORRECT AXD AGREE TO COMPLT
WITH ALL COUNTY ORDINANCES AND STATE. LAMS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. BHWAG DLP AL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY RE STFRED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED Y LOS ANGELES CAU AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT A THE LEGAL OW OF THE AS VE
DESCRIBED RE3IDE1ITI BACKFILL SEPTIC TAXED❑
SIGNATU BEEP.PIT{3) ❑ CESSPOOLS❑
OF PERYITfET
JOHN A. LAMBIAE. COUNTY ENGINEXR VALIDATION ROBERT A.WOOD, CHIEF PLBG. INQPE=0Ft
0.
( 051496 SEP 23 .1 A 4.50 9