HomeMy Public PortalAbout6160 CAMELLIA AVE_Sewer__ '•-"`•" APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
D"pwft .at of Conary F-uhu r
Coity' of Lw Angsd" BDILDING
JOHN A. LAMBIE, COUNTY EN61N"Ft ADDRI
m CAHaATT D. GRIFFIN, BUr'T OF BUIIDINO L•pCALl•nr .
NEAREST
FOR APPLICANT TO F111 IN CROSS ST.
LEGAL OWNER
DBbCRIFTION LAT NO.
MAIL
BLOC[ TRACT ADDRES6
OF BLDGS. 1 CITY TEL. X0.
SIZE OF LOT NOW ON LAT t.1
USE OF DISTRICT XO. GROUP M" PG
conrRAcroR
BUILDINGS .-�•�
__ B[ `
ADDIIFB CONHECnom DATA
• BTATIOn Z DEPTH
CITY n0. YANHOL.E REFEREVICY - UPP
.1 ell ®"'STATE LOWER
REG15TILATION NO. ❑ COUNTY
No, DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH-FROM
Y. CURB P.L. Y.L.TO P.L
PUBLIC SEWER $9.50 _
SEPTIC TAN[.SEEPAGE PIT OR
PITS AAD/OR DRAINFIELD 0 43.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P: c. XO.
E(TNi
.,CESSPOOL DRYWELL MANHOLE Q 2.00 CO, IMP, N0. JOB MO.
i HOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL SYSTEM ® S 1.00 TRUNK PERMIT X0, ROAD PEtRMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
i
WORK TO HOUSE SEWER 41.00 OO PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DI8POSALSYSTEM 11.00 WASTE APPROVAL
CHARGES
CONNECTION LHARGH PER- _
OWNERS PEEWT 3 1 00 Q
AUTHORIZATION I TOTAL FEE C740
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT KITFI THE HEREIN NAMED CON. AMOVAI$ DATE INSPECTOR•SSIGNATURE
i TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC S NEW HOUSE SEWER
SIGNED THI A 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGEAT SEPTIC TANK,SEEP,PIT(9)
ADDRESA AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE. LAWS REGULATING ALTER,REPAIR,'SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELFIR COUNTY AND STATE OF DISCONNECT
N CT PLUGHOUSE AND
CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF THE ABOVE
WER
DESCRIBED RESIDENTI PROPERTY. 13ACKFILL SEPTIC TANKS[ISIGNATURE - BEEP. PIT(S) E]SEEP.
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALMATION ROBERT A.WOOD, CHIEF PL.BG. INSPECTOR
C[. M.0.
LAf,0 6 8 2 3E, APR 4 . 4 2.0 0 m
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