HomeMy Public PortalAbout5819 CAMELLIA AVE_Sewer__ C[eDB 3-64
APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BOi LDiNG /
1TO-�____ TJ 1f11iF._ COADDRESS
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LOCALITY Z
HEAR[ST
FOR APPLICANT TO FILL IN CROSS ST
LzOAL
D[fCRIFTION LOT NO. OWNER
'U(IL
BLOCK TRACT ADDRESS 9
�(
O. OF BLOOM. CITY �.i(� 1 �G
BIZ[ OF LOT NOW ON LOT TEL. NO.
UBE OF DISTRICT NO. 2MAP rROCEJI SID By
■U LDIMO/ SK PO
CONTAACTOR\./",'l('! roa4p ' O w i / jt rr
ADDRw//or /G //�tl, f�d�a/ t NNECTION DATA
clrr
/V� LSA aOtL- TEL. NO. — S/or t STATION DEPTH
STATE MANHOLE RREPTRZNCE TIER .
R[01/TATIOIi NO. /[TO O O COUNTY LOWER
No. QRSCRIPTION OF WORK FEE TYPE Or CONNECTION [NQTH FROM
HOUSE■EWER CONNECTING TO Y. CURD P.L,
PUBLIC/iW[R $15.00 P.C.NO. �+
PITS AND/OR DRA NFIELO $10.00 CO.IMP.NO. JO■NO. 0
14 OU/E/ ER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V
PRI VATZ DISPOSAL SYSTEM 11.00
CO Abbiti6HALAFFIDAVIT [Y TBTST RECORD.IN■TR.NO. DATE 0
WORK TO HOU■E SEWER $2,00 `��
Cea
OVE11 OW S A06 PIT,DM NF1 D
LXTN.,CES/TOO k,DRYW LMAHHOL[ $15.00 Hvry,OR ST.WIDENING
AL-11, HOUSE CL
SEWER OR D BPOSAL SYSTEM, .00 STATE ENCROACHMENT 2
PERMIT NO, L
INDUSTRIAL
WAST[APPROVAL
CHAROES
OWNER'S PEHDUT t a o0
AUTHORIZATIONTOTAL FEE CONNECTION CHARD[
'/SIGNATURE
'1 HAVE AT THIS DATR A CONTRACT WITH THE HEREIN -NAMED CON- RIIMBURyEME FEE
TRACTOR TO CONN[OT THE ABOVE DESCRIBEDDWELLING APPROVALS
TO THE rUBLIG SW[R. DATE INSPECTp R
D
S[GNED THIS,_DAY OF 10_
OWNER OR NEW HOUSE SEWER
OWNERS A09NT CONNECT ADDITIONAL
■UJLDING ORWORK
ADDRESS 6111-TIC TANK.SEEP.PIT(S)
1 HEREBY AGKNOWLEDG[ THAT I HAVE READ THY■ APPLICATION AND/OR DRAINFIELD
AND STAT[ THAT TME ABOVE 10 CORRECT AND AOR[[ TO COMELY
WITH ALL COUNT' ORDINANCES AND STATE LAWS REGULATING CESSPOOL ❑ DRYWELL ❑
PLUMBING AND ■EWERS.
IHEREBY CERTIFY THAT I AM PROPER).Y REGISTER
RED AHD/OR ALTE .REPAIR,/EWER OR
LIC[N■[D AS REOU IRED BY LOS ANGLES, COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
FOR NIA OR THAT 1 AM THE LEGAL
CALIER OF, AND INTEND TO DISCONNECT PLUG AND
RUID[ IN, TH[ VE D[MCR]3[D 7T PK RTI'• ABANDON HOUSE SEWER
S 10 N'ATU RE BACKFILL/E FIE:TANKS
OF NERMI S[tT.PITCH LJ cL"POOLJ
ATION ROBERT A, WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
L1 Llo 5 0 0 4 tS SEP 2 9 1 0 D 5,00--
-_
79'° APPLICATION FOR PERMIT
7f;A/41D COUN" OF LCIS ANGELM SEWER—SEWAGE DISPOSAL
DEPIIBTIENT OF comay EMS BUILDING
BUMDIMG ALADD SALMY DrMOn ADDRESS / e//fes
LocAuTT C
NEAREST
FOR O CROSS ST
LEGAL OWNER dv� �J�a.6cr
DlSCRIFTON LOT N0.
BLOCK TRACT 1WL
ADDRESS
SIZE OF LOT NoOF N LOTS' .3 G tY
USE OF
7e DISTRICT MO.IY�,,i!`-
MAP @T
BUILDINGI
DI !4
CONTRACTOR 6 a -',x /,36 �fJ �
ADDRESS 6 �yi y �; CWL EA r0 qN D rAl
ctTr TSL No. �'(/.� ^'SAa2 D STATION DIFfH
REGISTRATION NO. I.31 .6 A D CoUMrT �A11HOLd C! UPPER
NO. I)V-SCRIPTION OV WO FIEE
HOUSECSEl1ER CONNECTING TO
Pl1BLI SERER 0 43.0o TTPE w IoN Lar FRO■ .
SEPTIC TANK,SEEPAGE PIT OR T. CURS F.L ■. TO P.L.
PITS IC OR DRAINFIELD
OVERFLO SEEPAGE 14DRAII IELD
OUSt SEWER COMMES-YCF G TO P' -
CCpp E p ol��{L 0 S1,60 CO. IMP.NO. 0.
IMOR TROT&OUSJISE R �G.OR ` Q TRUNK PERMIT H0. PmtYIT No.
PAI OR ABAN X HOUSE 41.0.0 1TA7E ENCROACHIEN"C
PERMIT N0.
INDUSTRIAL
WASTE APPRO
CHARGES
owwws PM-UT O0 CONNEC'CION CHARON FEE
AUTSOMAnON TOTAL FEE d D REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN TUNED CON-
TRACTOR TO COXXECT THE ABOVE D[SCBIBED ¢1sTllIT_DREI, AMOv DATE INSPECTOR'S IIGNATURE
TO THE PUBLIC SEWER
601
SIGNED THIS SAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDMQNAL O
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SECyP.PIT{s)
ADDctFts p1..D
AX OR BRAIXFI -
Ll
BT ACKNOWLaDGa THAI 1 HAVE READ THIS APPLICATI XTE THAT THE ABOVE H! CORRECT ANP /I��OREE TO COMP T CESSPOOL DRTWELL COUXTT ORDINANCES AND STATE Inew REGULAT G ALTAR,REPAIR,SEWER OR
G AILD SEWERS. SEWAGE DISPOSAL ST ■
I1IT CERTI THAT I A■ PF{OPERLT RL�GISTERED AND/OR pISCONN CT PLUG AND
D AS REQUIREDBT LQ9 ANGELES COUNTT AND STATE OF ABANDON HOUBfi SE►ER
XIA OR THAT I AYTHB LEGAL OWNER OF THE ABOVEED RESID L PRO CRTT ^ MMP.BACKITLL S C ESKERElfEEEP.FIT CEfaP00Li
■
m■ l�/JaKV/�Fii�Y. ROBERT WOOD
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