HomeMy Public PortalAbout6056 CAMELLIA AVE_Sewer__ I1-j" APPLICATION FOR PERMIT -—-, l 7
COUNTY OF um "am SEWER—SEWAGE DISPOSAL.
DE PARTME2U'OF'COUNTY ENd1M
BUIIXMG AND SAFETY- Dri=C)N B61LDING
C�]omf A. I KBS. C=2kT ADDQ£�
Tf D. GWaP M bap t -
FOR APPL.I TO FELL IN Q fff r -
LEGAL
DESCRIPTION LOT N0. d /
L (6 C? ADDRESS
NO.OF BLDGS.
SIVE OF LOT NOW ON LOT ITT 'XO
USE OF
B I I G DISTRICT N0. GROUP IAP
CONTRACTOR �o CO-.,�- 4r � /,E Pp /
ADDRSES _ � Lv CONNECTION DATA l.�
CITY- -� TELA d ATION '�S DEPTH
(TATE UAHOLE QIFMMCE Q UP
REGISTRATION XO_ COUXTT
No. DESCRIPTION F R FEE
HOUSE SEWER CONNECTING TOV*JLDO
Py
PUBLIC SEWER V TrpE9F ON LENGTH FROA
SEPTIC TANX,SEEPAGE BIT OR �, Rg P,L ■.LTO P.L �7
PITS AMD/OR DRAINFIELD
OVERFLOW PAGE PIT,DRAINFI
FITX. CESSPOOL DRTWELL IAN HHOUSE SEWER CONNECTING TOP.C.N0.
PRIVATE DISPOSAL STSTEM CO.IMP.N0. Z JOB No.
CONNECT ADDITIONAL BLDG.OR •7
TORIC TD HOUSE SErEQI.DO TRUNK PERMIT NO. ROAD PEA■lT X0.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 1.08 ITASE ENCROACHMENT
PERMIT NO.
Il!iippUSTIIIA
- ll%TE APPkOVAL
CHARGES
Off$ PEMMIT 00 CONNECTION CHARGE FEE
AUTHOBPZATIO -TOTAY --- - - �MPO_ REI7YBURSEMEXT FM -
I HAVX AT THIS DATE-A-CONTRACT WITH THE HEREIN-NAMED CON. - -
TRACTOR TO CONNECT THE ABOVE DESCRIBED EIIMNG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWILL
SIGNED THI AY OF 1 NEW HOUSE SEWER OR - - _ -- - - CONNECT-ADDITIONAL -
N£QB AG BUILDING OR WORK
ADDR -- SEPTIC TARK,-SEEP,PITO)
ANDIOR DRAINFIELD
I HEREBY ACKNO LEDGE T I HAVE READ THIS APPLICATIO
AND STATE THAT THE ABOVY IS CORRECT AND AQREE-TO COMPLY- CESSPOOL DRTWELL - - --- ---- -WITH ALL COUNTY -ORDINAMCED ANIf VATS LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. .SEWAGE DISPOSAL WERST3OR -
I HERESY CERTIFY-THAT I -PROPERLY-`-REGISTERED AAD/OR SEWAG DIS PLUG AND
EN
LICENSED AS REQUIRED BY LO ANGELES COU!(TT AND STAT[ OF
CALIFORNIA OR THAT I AM LEGAL EQ.9F- 7H)i ABOVE -ABAIIDON HOUSE SE7ER
DESCRIBED QHSIDEATIAL P BACtF1LL SEFT C TANKS
SIGNATURE SEEP. PIT E CESSPOOLS -
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6F'PER■ .
�* - ATION ROBF-RT A- W00t) -
at ■.o. �..■ MLJF'tRV on4a tmaHAmc m,iNalt•1HER
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