HomeMy Public PortalAbout5332 CAMELLIA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING �] J� i 7. 1 1 NEAREST
ADDRESS �j ✓ Jf,S �,�p{ Jl +' CROSS ST.
LOCALITY f4 Jv:, 4 ,<'��_ � DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST �� A - S
CROSS ST. jl
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER �'
MAIL
ADDRESS f e USE ZONE I OCCUPANCY MAP
I
BK PG
CITYTELNO,
CONTRACTOR
CO.IMP.NO. ----
ADDRESS
JOB N0.
CITY TEL.NO. ,r TRUNK PERMIT N0.
/�JO�� .f Lf STATE — -
REGISTRATION N0. C.� Y ROAD PERMIT N0.
LEGAL /qq
DESCRIPTION LOT NO. /tJ STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 7 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BL .rte'
NOW ON LOTT CHARGES
USE OF
BUILDINGS_ . s' -+/irL CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK AE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER S 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD6.OR EXCEPTION 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/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER _---L-OWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ i 00 B.
Y.----._--GUR _ P.L.- M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF........................................19..__._ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------------------------------------------------------------------.--_..._ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.......................-..................------------------------------------------------ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL El
CATIONAND 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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RE DENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE 'S// �, ` rI ��j�� �' SEEP.PIT(S)� CESSPOOLS
OF PERMIT LICSa- -.-t_'F`._`�. - �I�._�!..Y..!��"_{.�
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