HomeMy Public PortalAbout6108 CAMELLIA AVE_Sewer__ D
S&E-663 II.85 APPLICATION FOR PERMIT 1
8 @ E-8
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
0A I
® CASSATT D. GRIFFIN, SUPT OF BUILDING +
LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT /� ADDRESS
! N0. OF BLDGS. CITY TEL. NO. i
SIZE OF LOT NOW ON LO !/
USE OF
BUILDINGS D DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR -
CONNECTION DATA
ADDRESS r 0
M STATION DEPTH
CITY TEL. NO. _ MANHOLE REFERENCE
P-ISTATE of _�// LOWER
REGISTRAT N IVO. ❑ COUNTY
No. DESCRIPTION OF 0 K FEE
HOUSE SEWER CONNECTING TO TYPE OF TION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
I
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO. IMP. NO. JOB NO.
I HOUSE SEWER CONNECTING TO O
I PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
I
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 _ WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
' OWNER'S PERMIT 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL 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. NEW HOUSE SEWER '
SIGNED THIS DAY OF r 1'Q CONNECT ADDITIONAL
OWNER OR � y _BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS 0 AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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 JOS ANGELES COUNTY AN STATE OF AN DON HOUSE SEWER
CALIFORNIA OR THAT I M THE LEGAL OWNER HE V IV
CRIREST T PERTY. ACKFILL SEPTIC TANKS❑
iii666 T(4R'E� �r tSEEP_.PITS) ❑ CESSPOOLS �� : i - � ,{i/"
F PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N. 0. ASH
I C 4 APR 9 4 4.5 In