HomeMy Public PortalAbout5102 CAMELLIA AVE_Sewer__ nr w T OF OOUNTV IKNGINKER SEWER—SEWAGE DISPOSAL 1
�rTgION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF 1.08 ANGFff
WILLIAM J. FOX, COUNTY ENOIN[[R BUILDING L/�
ADDRESS J ( (o
FOR APPI-IgANT TO RLL IN LonALITY BUILDING NEAREST - 71 �
ADDRESS GROSS ST, lJ
LOCALITY DISTRICT NO. SERIAL NO. PERMIT M0. c
NEAREST S
CROSS ST.
�EC IVSD BY Ready fw IrsPwtIcm !DATE ISSUED
OWNER .MAIL -7 `'. I-w
ADDRESS d 1 �� UAE OCCUPANCY YAP re
r ry TEL.NO. '4_'j-6p /0�
CONTRACTOR 42':�&2 �U!'�-o� 00.1 .NO.
ADDRESS JOB.MCI
CITY TILMO. TRUNK PE IT NO.
STATE
REGISTRATION M0. COUNTY ROAD PERMIT 0.
LEGAL STATE ENCROA HENT
DESCRIPTION LOT M0. ,��..��.... PERMIT N0.
BLOCK TRACT ��J�y INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT ��7d NOW OM LOT` CHARD
UBE OF
BUILDINGS E /!5rl�� CONNECTION CHARG[TEE
NO. DESCRIPTION) OF WORK FEE
R[IYBURSEYEMT FEE
HOUSE sewEa CONN OTIN TO
PUBLIC SEWER >L6[ RECEIPT M0. DA BY
HOUSE SEWER OOM ECTI G 0
PRIVATE DISPOSAL SYSTEM 1.414
NNE ADDITIONAL L G•OR EXCEPTION RECORD D
WORK TO HOUSE SEWER I 4NO.
ALTER OR REPAIR EXISTING :,. DAT[ BY
SEWER OR DISPOSAL SYSTEM IJIO
ISOONM AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.04 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OB t:
PITS AND OR DRAIMFIELO 2.M V _ DEPTH
OESSPO
L—DRYWELL
SPECIAL OONDITIONS ONLY 2.11011 MANHOLE REFERENCE
UPPER �s LOWER
TYP�OF OONNECTIOM LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PF-R1�IT i I oo - _
AUTHORIZATION TOTAL FEF D 0
I HAVE OONTRAOTOIR TO CO NES DATE OT THE ABOVE DESCRIBED EXISTIND WITH THE HEIMM G APPROVALS INSPEC OR'ESIGNATURE DATE
DWELLING TO THE PUBLIO SEW[B
SIGNED T1-II Y D F Z I NEW HOUSE SEWERc6V
ME ORE OONNEOT ADDITIONAL
OvmRs G
BUILDING OR WORK
6EPTI0 TANK,SEEP.PIT(S)
ADDRESS AMD OR DRAIMFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE "AD Is APHJ• CESSPOOL Ej DSYWELL❑
CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO 00INPLY WITH ALL COUNTYORDINAMM AND STAT[ LAWS ALTER REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAdE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUG A D
AND STATE OF CALIFOR AA�CRAT 1 AN THE LEGAL OWN-
EB OF THE ABOVE DEMTIAL PQOP[RTY. OTA []
BEEP.PIT(S)[] CESSPOOL6 E]
SIGNATURE
OF PERYITTE
TtAaud 663 T/as