HomeMy Public PortalAbout5322 CAMELLIA AVE_Sewer__ DFXAlLTMENT OF OOTTNTY ENGTNEKR SEWER-SEWAGE DISPOSAL
DIVISION OF BUU-DING AND SAFETY PtRMIT APPLICATION
OOTTNTY OF LOS ANGFT,
WILLIAM J. FOX, Courtrr EHOIHEiH BUILDING
ADDRESS
FOR A/�PPLICANT TO FILL IN LocAUTY
BUILDING / y�, —,t/ ORoes ST.
EAREST
ADDRESS .{
LOCALITY DISTRICT NO. SERIAL Md. PERMIT NO. c
NEAREST S
GROES ST. 2, rF+
ECEIVED BY Rum iK lupeotlo■ DAT[IEEUfiD
OWNER
MAIL USE ZONE OCOUPANOY MAP PQ
CITY
CITY 00' T[LE0. —
CONTRACTORcz,zz �~ --000.
ADDRESS ��� /,tJOS.N0.
OrTY �� TiLNO.�j Q•�19?p TRUNK PERMIT No.
rl
REGISTRATION NO. 11:76'1,- C- /� 0 TEtDLry ROAD PERMIT 110.
LEGALSTATE ENCROACHMENT
DEdORIPTION LOT N0. PERMIT NO.
BLOCK TRACTZ Z�2'0 WAST8E A PROVAL
SIZE OF LOT N0.OF BLD -12
NOW ON LOT CHARGES
UDE OF DONNE CHARGE FEE
BUILDINGS - ` vC. �'
NO. DESCRIPTION OF WORK FEE
REIMBUREEMEN
-HOUSE SEWER
PUBLIC SEWER ! 5-60 O RECEIPT NO. TE BY
HOUSE■EW[ c)omxEOTING To
PRIVATE DISPOSAL SYSTEM 1.00
OOkNECT ADDIT DNA LElLbiL OR EXCEPTION REOOB
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIREXISTING
NO• DATE B
SEWER OR DISPOSAL QYETEM IAO
DISCONNECT AND ABAN ON 9itWER
AND/OR DISPOSAL SYSTEM1.00 CONNECTION DATA
SEPT
1 TAN ,8E PAGE PIT R
PITS AND/OR DRAINFIELD 2m STATION DEPTH
EESPOOL—DRYW[LL
SPECIAL OONDITIONS ONLY 2-M MANHOLE REFERENCE
LOWS
TYPE OF OONMECTIO LENGTH FROM
Blt$S Y.L TO PA_ ZQ
OWNERS PERMrr s I 00
AUTHORIZATION TOTAL FEE IV Lry
1 HAVE THIS DATE 001fTRAOTED WITH THE HEREIN NAMED
0ONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING To THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER I - - ,So
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK.SEEM.PIT(E)
ADDRESS AND/OR DRA NFI[LD
1 HEREBY AOKNOWLEDG[ THAT I HAVE READ THIS APPLI• CESSPOOL[ DQYWELL
CATION AND STATE THAT THE ABOVE IE CORRECT AND AGREE
( TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSALTfiR REPAIR,dEWER OR
REGULATING PLUMBING AND SEWERS. SEWAdE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I Al THE LEGAL OWN. ABANDON HOUSEEEWER
EB OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BAWFILL SEPTIC;TANKSSIGNATUE ❑
�., � SEEP.PIT(S)Ej CESSPOOLS o
OFp
PERMRTTEE A9 G°-'-�-�4tf <:�
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DEPARTMEA'T OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL Z
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ! BUILDING
ADDRESS .
FOR APPLICANT TO FILL IN LOCALITY_ - .
BUILDINGNE
�' ,.-� �- AREST
ADDRESS
CROSS ST.
LOCALITY DISTRICT NO. SERIAL Nd. PERMIT NO. C
NEAREST -�1 Vi J
CROSS ST.
S RECEIVED BY Ready for Inspection DATE ISSUED
OWNER E.I --"-.
L.
MAIL USE ZONE OCCUPANCYBK MAP PG
ADDRESS
CITY - TEL.NO.
CONTRACTOR
R 3t
ADDRESS JOB.NO. ^L
CITY TELAO. TRUNK PERMIT N0.
STATE
REGISTRATION N0. / 8 ISOTNTY ROAD PERMIT NO.
LEGAL - STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT i INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDG3. CHARGES
NOW ON LOT
USE OF
-BUILDINGS �r CONNECTIQNI CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENFFFX
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 _ RECEIPT NO. `»- TE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORbvu.,
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE BIT" •_,��
SEWER OR DISPOSAL SYSTEM 1.00 '�
i DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR N l
_ PITS AND/OR DRAINFIELD 2.00 STATION j� DEPTH
CESSPOOL—DRYWELL (
SPECIAL CONDITIONS ONLY 2.00 I �� MANHREFERENCE SLOW
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 M.L.TO P.L.
AUTHORIZATION ( TOTAL FEE
I 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..-._-_-___- _.--_.._._.-19__ NEW HOUSE SEWER
ONECT
OWNER OR BUILDING OR WORKAL
OWNERS AGENT-..-.. - - - - - - - --- --- -- _
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.. -... - -..-.... - - - - _ _ - - - - --._... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL E]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATINGPLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE-SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURESEEP.PIT(S)[] CESSPOOLS E]OF PERMITTEE..:-- --I � ... '"
76AG42A 663 7/53