HomeMy Public PortalAbout5802 CAMELLIA AVE_Sewer__ APPLICATION FOR PERMIT
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DIVISION OF BUMDING AND SAFM S EW E RAS EWAG E D I S POSA L
Dopm mag of Cenm Finabu.r
Co=fy of Los Angelm FAN" INq
Wil.J.FOX, CourrrY 6xaimam cAsaA,rr o.aN]FTI1i,. cR tlmmDwFOE APPLICANT TO FILL IN N
LEGAL
DESCRIPTION LOT IqO.SM OWNER
BLOCK TRACT C f WAIL
ESS
NO. OF BLD99. '
SIZE OF LOT NOW OX LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP YAP
ley // PG
ey / PG
CONTRACTOR
ADDRESS92,M rA COMC=Ox DATA
CITY TEL. N0. STATION -76- DEPTH
❑ STATE MANHOLE RUrREACE �� UPPER
REGISTRATION NO. f Q ❑ COUNTY 1-22
No. DESCMPTION OF WORK FIE
HOUSESEWER CONNEICTINd TOTYPE OF CONNECTI LENGTH FkOY
I PUBLIC SEVER 9.50 Y. tURB P-L'; N.L. TO P.L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR O. JOD XOO
WORK 7D HOUSE SEWER 1.00 CIMP. N0.
ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT NO. -;7,
1 SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
l SEPTIC TANK,SEEPAGE PIT OR INDUSTRIAL
PITS AND/OR DRAINFIELD 00
CESSPOOL-DRYWELL WASE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNER'S PST s I 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE COXTRACfED WITH THE HEREIN mAlmED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED UISTIPIQ DW ELL.JNG APPROVAL D TE IX9r EtT '$ft TURK
TO THE PUBLIC 3EWIER
SIGNED THIS _DAY OF lfl NEW HOUSE SEWER 3
OWNER OR CONNECT ADDITIONAL
OWXERS AG BUILDING OR WORK
9EPTIC TANK,BEEP, PIT($)
ADDR AND/OR DRAIHFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE RrAD-T)JI3. APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE Ipp CORRECT A.X6 AGREE TO COMPLY
WITH ALL V�OOUNTY ORDINAlq AND fTATY LAWS REGULATING ALTER,REPAIR.(EWER OR
PLUMBING A.ND $EWERS. SEWAGE DPAIR. SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELKS COUNTY AND STATS OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AN THE LEGAL OWNfiR OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILLC TANKS❑
y .r SEEP.PIT CESSPO LS
fIGXATURe
OF PBRYIiTEE
Wilt ►AY J.FOX.Couwry F-No zxR VALIDATION FL A.WOOD, Cmimy PLma. trurccroN
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