HomeMy Public PortalAbout5956 CAMELLIA AVE_Sewer__ DEPAIi12ffENT OF OOUNTY ENOL EM I SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUB-DING AND SAFETY ! PERMIT A PLICATION
OOUNTY OF IAS ANGE7M
WILLIAM J. FOX, CourITY END11N[[Q BUILDING
A D D R
FOR APPLICANT TO RLL IN LOCALITY.
BUILDING NEARE8T
ADDRESS CROSS 8T.
LOCALITYD18TRICj NO. SEWA PERMIT M0. c
NEAREST �J A J
CR088 ST' EO IVED BY Remy for lagwe en DAT ISSUED
OWNER �2_/*,- .�
MAIL 1 U ZO CC PANCY MAP
ADDRESS BK PG
CITY TELMO.
CONTRACTOR CO.IMP.NO.
ADDRESS r
10B M0.
CITY TELMO. -7-z3 I TRUNK PERMIT M0.
&TATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL � STATE ENCROACHMENT
DESCRIPTION LOT M0. ` PERMIT N0.
BLOCK TRACT /►d� INDUSTRIAL
O A WASTE APPROVAL
SIZE OF LOT , Q� 7. IN,WOON LOTS 4 CHARGES
USE OF
BUILDINGS OOMMEOTI M CHARGE FER
NO. DEEICRIPTION OF WORK FEE
REIMBURSEMENT F
HOUBIE&EWER OiOMMEOlnMG TO
PUBLIOSEWER L54 � RECEIPT NO. D
PRIVATE DISPOSAL SYSTK■� I.M
CO NM N ON RECORDED
WORK TO HOUSE SEWER - 1.40
ALTER SB kEI3AItI EXI&TINO DATE BY
SEWER OR DISPOSAL SYSTEM Ido
DISCONNECT AND ABANDON S VER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
TANK,sEEPAG R PIT Oill /
PITS AMD ORDRAINFIfiLD ?J4 STATION f l DEPTH
RYW LL
SPECIAL OONDITIONS ONLY LM NUTTER EFERENOE
TYPE 0CU B IOM LENGTH FROM
�
OWNERS PERMIT ; I Y. P.L.P. M.L TO P.L.P.
AUTHORQATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOB'SSIGNATURE DAT$
DWELLING TO THE PUBLIC SEWER
SIGNED THIS CAY OF Iq_ NEW HOUSE SEWER
OWNER OR OOMMECTADDIOMAL
OWNERS AGENT WLDING OR WORK
8EPTIO TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAIMFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLI- CESSPOOL[] DRYWELL E]
CATION AND STATE THAT THE ABOVE 18 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 CEBTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LIOENBED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESORJBED RKSIDEMTIAL PROPERTY. L OTAN
SIGNATURE SKEP.rIT(S)11 CESSPOOLS
�L�� /�'r�
OF PERMITTEE
TEI"u an T/u
J