HomeMy Public PortalAbout5944 CAMELLIA AVE_Sewer__ DEPAKTNOENT OF OOUIgW EN(UNEER SEMfER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUWW QF LOS ANGEL
WILLIAM J. FOX, CouNrY ENaim[KR BUILDING
ADDRESS
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FOR AP PUCAWFILL IN LOCALITY
BUILDINGm <</r1 NEAREST
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LOCALITY ,L /�- DlSrel aE1Iu No. 1rr o
A / S
t CRO K
SECEI D BY Rea*fw losp tIN DATE IVUED
OWNER14 / 7 "r
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ADDRESS H J
.CITY _ TELN0. I ` BKS\ PO
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CONTRACTOR m Co.IMP.N0. D
ADDRESS p 8 �lL.L JOS NO.
CITY Q TELNO. )��J(�
TRUNK PERMIT N0.
ATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT' / INDUSTRIAL
M0.OF BLDGB- WASTE APPROVAL
81Zfi OF LOT��J�� J NOW ON LOT CHARGES
USE OF
DI Jl f�j� G,/,d
BUILDIN88 �J L.��/6i � CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
REIMBURSEMENT FEE
PUBLIC SEWER ! $ &W RECEIPTNO. DATE BY
HOUSE SEWER CONNECTING 0
r
PRIVATE DISPOSAL SYSTEM 1.00
ONAL 00k.09
WORK TO HOUSESEWERL IAC C� EXOEPTIONRECORDED
A 0 R PAI NB NO,
DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTICEPA PIT OR
PITS AND/OR DRAINFIELD 2.m STATION DEPTH
CESSPO L� L
SPECIAL CONDITIONS ONLY 2-NI�� MA HOLE REFERENC� j]
_ _F UPPER L94MRR
TYPE OF EANECTION LENGTH FROIr
OWNERS PEXMrT ; 1 00 P.L. M.L TO P.L /V
AUTHORIZATION TOTAL F
1 HAVK THIS DATI< CONTRACTED WITH THE HEREIN NAMED
DONTRAOTOR TO CONNECT THE ABOYE DE IBED EXISTING APPROVALS INSPECTOR'BSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER _
SIGNED THIS -3 DAY OF I NEW HOUSE SEWER _
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR K WORK
SEPTIC TAN
ADDRESS
A ND DRAINFIELD PIT(8)
1 HEREBY ACKNOWLEDGE THAT I HA E READ THIS APPLI- CESSPOOL[-] DRYWELL
CATIONAND STATE THAT THE ABOVE 18 CORRECT AND AGREE
-TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATIND PLUMBING AND SEWERS- SEWAGE DISPOSAL SYSTEM
1 HEREBTI
Y CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUQ AND
AMD/OR LIOENSED ASREQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE G AND
AND STATE OF CALIF IA OR THA ANT LEGAL OWN-
ER OF THS ABOVE IBE PE _UcTA ❑
E19 N ATU RE SEEP.PIT(S)E] OfiS8P00LS
OF PERMITTE
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