HomeMy Public PortalAbout5032 CAMELLIA AVE_Sewer__ DEPARTMENT of OOUNTY EDNGINEM SEWER—SEWAGE DISPOSAL 1
DfVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF L08 ANGEL
WILLIAM J. FOX, CouNTY ENOINZER BUILDING �O ^� ^ /p /4
ADDRESS ti� Z, /�' r G,H ��/F��f*
FOR APPLJCANT O RLL IN LOCALITY C
BUILDING NEAREST
ADDRESS X ORO SG ST. f►
LOOALITY DISTRICT MQ. A SEMAL M0. PERMIT NIL c
NEAREST _ A O Q ^ S
CROSS ST. '� '' ECE VED BY Rwf1 fir IospMtIN 'DATE ISSUED
OWNER ! `
AD AIL OMESMS USE ZONE OOOUBK PAMCY MAP
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OONTRACTO 00,IMP.M0.
ADDRESS ^ JOG NO.
CITY TELN0. T1tUNK PERMIT NO.
19TATE
BEGISTRATION NO. B COUNTY ROAD PERMIT NO.
LEGALSTATE ENCROACHMENT
DESCRIPTION LOT N0. 7.tv, PERMIT NO.
BLOOK TRACTzyw INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT Y0.0 BLDG& CHARGES
NOW OM LOT
BUILDINGS ) a .r:► - CONNECT]
USE ON E FEE
NO. DEBCF41PTION OF WORK REE RHIMBURS[lrE11T FE
PUBLIC SEWER N IM O &W RECEIPT NO. Tfi BY
HOUSE SEWER MME MG TO
PRIVATE DISPOSAL SYSTEM IAS
WORK TO HOUSE SEWER I,H 0 OEPTIOM RECORDED
AL OR REPAIR I N NO• DATE BY
SEWER OR DISPOSAL SYSTEM IAS
ISOO MELT ANb ABANDON SEWER
AMDOR DISPOSAL SYSTEM Im CONNECTION DATA
S I ANK,SEEPA PIT ON
PITS AND/OR=
2AS STATION 2i DEPTH
ESSPOOL—D LL
SPECIAL CONDITIONS ONLY 2-K '��� - �A H P EFEREMOE
TYPE OF DONNECTION LENGTH FROM
OWNERS PERMIT I 00
Y. CURB P.L. M.L TO P.L
;
AUTHORIZATION TOTAL FEE Cc,
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------DAY OP Iq_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL j
OWNERS AGENT BUILDING OR WORK •gyp s
8EPT10 TANK BEEP.PIT(S)
ADDRESS AND OR DBA NFIELD
I HEREBY ADKNOWLEDQE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINAMOES AND STATE LAWS ALTER REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVS-0,84CRIBED ESI fNTIAL P PERM AM []
SIGNATURE !" 0 f BEEP.PIT(S)� CESSPOOLS Q
OF PERMITTEE_ r l' �J
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