HomeMy Public PortalAbout5328 CAMELLIA AVE_Sewer__ DEPA rIXENT OF COUNTY ENGINIE= SEWE"EWAGE DISPOSAL 1
DIVISION OF BUUMING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS AN(EI.EB
WILLIAM J. FDX, COUNTY ENOIN[[R BUILDING
ADDRESS 3 'y � f A
FOR APPLICANT TO RLL IN", LOCALITY
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ADDRESi ,
LOCALITY DISTRIOT NO. 8ERIXL Na PERMIT Na C
NEAREST A S
CROSS ST. RECEIVED BY Ready fwInspwtts■ DATE ftSUED
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REGISTRATION NO.
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LEGAL STATE ENCROACHMENT
DESCRIPTION LOT R0. PERMIT NO.
BLOCK TRACTr' -7 -D INDUSTRIAL
W APPROVAL
SIZE OF LOT
m&OF BLDG& CHARGES
NOW ON LOT
USE
BUILDINGS rL ,� CONNECTION CHA EE
t�'--,�
Ma DESCRIPTI N OF WORK FEE
OU8 8 E CO REIMBURSEMENT FEE
PUBLIOSEWER &ZG 1 RECEIPT NO. A BY
USE SEWER 0011IN NG TO
PRIVATE DISPOSAL SYSTEM 1.50
GONMEOT ADDITIONALOB EXCEPTION RECORDED
WORK TO HOUSE SEWER IAS N0.
ALTER OR REPAIRINR DATE BY
SEWER OB DISPOSAL SYSTEM Im
DISCONNECT AND ABANDON SEWER
--AND/OR DISP09AL SYSTEM Im CONNECTION DATA
lEM0 TANK,SEEPAGE PIT 08
PITC AMDOB DRAINFIELO LJS STATION DEPTH
PO —DRYWTiLL 79
SPECIAL CONDITIONS ONLY LAS / MANIHOLEREFERENCE
ER
TYPE OF 00N [QnoN ENGTH FROM
OWNERS PERMIT ; 1 00 Y. CURB P.L Y.L.TO P.L.
AUTHORIZATION TOTAL FEE d
I HAVE THIS DAT[ DONTRACTED WITH THE HEREIN NAMED
QONTRACTOR TO DONN[OT THE ABOVE DESCRIBED EXISTING APPROVALS SPECTO S SIGNATU DA
DWELLING TO THE PUBUD SEWER
SIGN®THIS DAY OF 19_ NEW HOUSE SEWER �/ J
OR DONNEOT ADDITIONAL
OWNERBUILDING OR WORK
OWNERS AGENT
rAUANDON
NK SE[P.PIT(i)
ADDRESS D NFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE HEAD THIS APPLI- L DBYWELL
CATION AND STATE THAT THE ABOVE IS OORR[OT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCSM AND STATE LAWSEPAIqq,,SEWER OR
REGULATING PLUMBING AND SEWERL DISPSdAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AMD/OB LIOENSED AS REQUIRED BY LOS ANGELES COUNTYECT PLUG AND
AND STAT[ OF CALIFORNIA OB THAT 1 AM THE LEGAL OWN- HOUS[aEWER
E8 OF TIDEABOVE DESCRIBED 8END[NTIAL PQOPEETY. [](S)� OnBPOOL EI
SIGNATURE ,�(•
OF PERMITTE
T&ABUA 687 T/68 G ,
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