HomeMy Public PortalAbout6101 CAMELLIA AVE_Sewer__ DF.PAiiTAfENT OF COUNTY ENco ER SEWE"EWAGE DISPOSAL
DIVISION OF ElUaMING AND SAFETY PERMIT APPLICATION
QOUNTY OF LOS ANGIFT
WILLIAM J. FOX, COLIN'fY ENGINEER BUILDING
ADDRESS _r1 I C .f l I
FOR APPLE TO RLL IN LOCALITY �' r
BUILDINGQ 1 �� oA CR098 ST.
ADDRESS
LOCALITY DISTRICT N0.ROSS SERIAL 110_ PERMIT NO.
CST. -T lid �Th I A b r-S
RECEIVED BY Rwao fR Iupwuon DATE(ISSUED
OWNER
MDAIL SE ZONE OGCUPANOY BK MAP PG
ADRESS -C.—
CITY �/}� r TELMO.
D a
CONTRAOTOR
ADDRESS
JOB.NO.
CITY �` I �Q TELNO. — TRUNK PERMIT NO
TE
REGISTRATION N0. ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. J STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT `7 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO. F BLDGS. CHARGES
NOW ON
LOT
BUIUILDING
DUSEOCONNEOTI ARGH FEE
BS
NO_ DESCRIPTION OF WEIRK WEIRFEE
REIMBURSEMENT FE
HOUR SEWER CO MH M 0
PUBLIC SEWER 41 111 S.H a RECEIPT NO. TE BY
HOUSE SEWER CONNECT'INGTO
PRIVATE DISPOSAL SYSTEM 1.00
DONNECIT AAL
BL G.OR CEPTION RECORD
WORK TO HOUSE SEINER I.M N0.
AL ER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM I.00
DISWNNECT AND ABANDON SEWER
AMD OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC AN ,SEEPAGE PIT OB
PITS AND/OR DRAINFIELD 2AG STATIOM DEPTH 1
E'SSPOOL—DRYWELL
8PECIAL CONDITIONS ONLY 2.00 / I pr MANHOLE REFERENCE OWE
TYPE OF CONNECTION LENGTH FROM
OWNERS PEFLMFT I Y. CURB P.L. Y.L TO P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE OONTRAGT[D WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DMIUBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THEPPUBLIO SEWER
SIGNED THIS-16--DAY OF 19s�� Mew HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS All
NTzwk BUILDING OR WORK
a SEPTIO TANK,SEEP.PIT(S)
ADDRESS AND OR DRA NFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLE- CESSPOOL I] DBYWELL❑
CATIONAMD STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AMD STATE LAWS ALTER REPAIR iFWHR OR
REGULATING PLUMBING AND SEWERS. BEIYA�E DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGEL COUNTY
AND STATE OF CALIFORNI/y0R THAT 1 AN THE GAL 0 ABANDON HOUBEZEWER
EB OF THE ABOVE D 7RIB D RES!p!"L EMT RMKFILL C K ❑ f •.
✓T' r 8EEP.PIT(i)� CESSPOOLS 1
SIGNATURE �1
OF PERMITTEE
TDA"IA 603 T/07 '