HomeMy Public PortalAbout5015 CAMELLIA AVE_Sewer__ APPLICATION FOR PERMIT i
Drf=ON OF BUELDING AND SAFETY SEWER-S SWAGE DIS POSH
Depatmwi ofCo�if�
�tr of Los BUILDING /` s
Wlil.J.FOX, COUNTY ENOimomm 'DDS v v
CASSArT D.4RIMM,Sup"TowIluu_ me LOCALITY
FOR A"MCANT TO = IN NEAREST
LEGAL
DKSCRIPTION LOT R0. ♦` /'� OWNER
BLOCK TRACT ,yy ` / ADDRESS
NO. OF BLDG$.
SIZE OF LOT NOW O CITY TIL. NO. '
USE OF
B ILDIN DISTRICT NO. GROUP YAP
BIC PG
CONTRACTOR
ADDRESS CO ON DATA
CITYLAO. STATION DEPTH
❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ❑ COUNTY LOWER
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM
HOUSE SkWER CONNECTING TO Y CURB P.L, L. TO P.L.
PUBLIC SEWERS a S 1.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYST-EM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. INP. NO JOB NO.
AMER OR REPAIR EXISTING
S ER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AHD/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
I SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIRFIELD .00 INDUSTRIAL
POOL-D YWELL WASTE APPROVAL,
9LAL CONDITIONS ONLY 2.00 CHARGES
OWN+rS PEMMIT00 CONNECTION CHARGE FEE
1
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS
DATE EABEON-
TRACTOROCONECT CONTRACTED
DESCRIBED EXISTING NAM
APPROVAL DATE INSPECTOR'SSIGNATURK
TO THE PUBLIC SEWER
SIGNED THIS SAY OF 19-
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPT C TANK,SEEP, PIT(S)
ADDIR"It AND OR DIAINFIELD
VI HEREACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWL[IAND EL
STAT THAT THE ABQQVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY OQDINANCES AND STATS LAWS REGULATING
PLUMBING AND SEWERS, PAIR
��U REPAIR,BEMEIt OR
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AHD/OR SEWAGE S SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ARD STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL QWN9:R OF THL ABOYR ABANDON HOUSE SERVER
DESCRIBED REBIDPROPIRTY. EACLFILL$ C TANKS❑
1 tIT S CESBPOOLS
SIGNA7(�R�
OF PERNrrTM �ITI •
WII IAM J.FOX.CouNrY rLNaLrtme Y ON R.A.WOOD, CIIIQ rLla. lm"mx row
I AP 065 ?N 5EP26 4 2.00 0
''"'" APPLICATION FOR PERMIT 1
COMM of r.Oa milmm
SEWER—SEWAGE DISPOSAL
=AWrX TIT OF CoUNTr EfaaO
BUUMBIG AND SAFkTT DIMON BUILDING
ADDRISS
CAW=D. GRIEF Mup t of buildba LOCALITT ILr
NEAREST
FOR APPLICANT O FlU IN CROSS sT LA
uGAL
DESCRItTIOR LOT■0 OW ft
BLOCK TRACTC [AIL
ADDRESf
[O.Ot gLDGS. _ -
IIZE OF IAT [0�0!f LOT No.
USE OF
BUILDINGS DISTRICT[0. GROUP ■11P P40CE3SED BT
COIITRI1C70 �► (• ��.�
ADDS COI�CIION DA�II
CFR TEL No, ' ? STATIOII PKP'TH
REGIIreAnoN No, d/� STATCOURTi [AiM0u M&IRENCK U'"KR
NO D FEE LOWER
MUNCIN&Ukkiehic To
�� AQg TTRE OF 0[ GTH FAOY
P11ly C ORD NFIm O 00 T. P. I TO t.
DYERfL
CHESP80L D [AIIHOLH 2.00
HOUSE SEVER CONNECTING TO �.c-[0.
PRIYATt DISP0SAL ZTDTE[ $1.00 CO.IMP.-No B[0.
CONNLDG.OR TRUNK MAIT[D. PERMIT�0. -
TORLCT DInO B1.00
A 0 AlID01f HOUSK STATS ENICROACHEW
SlSTSI41 fl.00 Pmum NO
• - +USTRltl1, - ,
CHARM
Owmmra PED= 00 CONNECTION CHAR FIX
AUTHOMUTION 'DOTAL FEE � REI[BURIII[ENr F}Di
I HAYS AT THIS DATE A CONTRACT TI'TH THY HYRSIN RkM CON- AMOVAM DATE INSPECTOR'S IIGYATURK
TRACTOR TO CONNECT THY ADM DESCRIBED i unille DTEWJ G
TO THI PUBLIC SEWER.
SIGNED THIR DAY OF 19— NEI.HOU31 SEVER
OTI�R OR CONNACT ADDiT OKU
O�NHR3 AGM BUILDING OR WORK
JLDDRMM = PIT(a)AIfK,SE�p -
ORCTDRAINtz LD
I HST ACKNOWLEDON THAT I HATI RX" TMS A."LICATIO[
AND STATE THAT THE ABOTE IS CORRECT A11D AG[[[ TO COItLT CEldt00
tTLCUCIBIh COUNTY INAYI t+ND {TAT[ LAYS REGULATING AL� AI SE7ER OjCxm SE7AGR
STSTElt
1 T CUM T THAT I A= ttOPERLY REGIS KIM AND/OR DISC011NICT PLUG liD
LI AS REQUIRED BT LOS ANGELHD STATE ES COUNTT AF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AN TH[ L "L OTIIIY T m IBOY[
DESCRIBED R=i' DEXnAL FROPltM. BACKFILL cTAi([I{]
SIGNATDA[ P
0 P
ri
44K ROBERTAL WOOD
at. i 1. VtrnntVMNQ UXCHAAIICAL.lQ OLMOM
2 1 3 QA SEP 4 1,O A 3.00 �