HomeMy Public PortalAbout5221 CAMELLIA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL-
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEERI ADDRESS ' �_I llCam P 1t,a
FOR APPLICANT TO FILL IN LOCALITY _T �c: ,
BUILDINGf NEAREST
ADDRESS 'S2 z� r CROSS ST.
LOCALITDISTRICT NO. A SERIAL NO. PERMIT NO. c
Y �1Qz� f
NEAREST n/ 125--),In r J
CROSS ST. (,J' yp�L„
E%
l L RECEIVED BY Ready for Inspection DATE ISSUED
OWNER I� . c r�� 4��1 r'
MAIL ��_ USE ZON OCCUPANCY MAP
ADDRESS fK, BK PG
CITY TELAO. `� A- 1
-
CONTRACTOR �.. �a ��e,fs �} CO ev • ARMIN14�10.
ADDRESS 'P
JOB N0. 3n 3
CITY TEL.NO.py'rETRUNK PERMIT NO. ---�_{
STATE
REGISTRATION NO. �S � 8 COUNTY ROAD PERMIT NO.
LEGAL d •L STATE ENCROACHMENT
DESCRIPTION LOT N0. O PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTS &X i C NNO.OF BLDG
OW ON LOTS , CHARGES
USE OF
DI t CONNECT HARGE FEE
BUILDINGS �,f,(."�
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT F
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 RECEIPT NO. I �'B�ritf I BY
HOUSE SEWER CONNECTING TO y
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.ORXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/ORDRAINFIELD 2.00 STATION _ DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ANHOLE REF_EWMCF
y UPPER ` LOWER
TYPt OF CONNECTION LENGTH FROM .4
OWNERS PERMIT $ 1 00 "Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE 3 OG
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 OF................_......................19NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR - - BUILDING OR WORK
OWNERS AGENT..._. _f r�+�+-_•--•_.- -----
SEPTIC TANKSEEP.
ADDRESS------------------------•-------------------------------------------•-------_------- AND/ORDRAINFIELD PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES 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 LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Ej
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE
OF PERMITTEE........... ---------------------------
76A642A 663 7/53