HomeMy Public PortalAbout6136 CAMELLIA AVE_Sewer__ 4630 DJ47
.40
CRA041D APPLICATION FOR PERMIT COIINrY OF LOS ANGUES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF rOUMY ENS
BUII.MG AND SAFETY DIVISION auILDINGESS
Eao� ADDR
WIIJSA1[�E.,) f•tfaA t of 8�i¢ 'LOCALITT
NEAREST
FQH ANT TO CRo
IFGAL I
DESCRIPTION LOT n0 PQ z
DLOC[ TRACT PAIL
N0.OF BLa ADDRESS
SIZE OF LOT NOW On LOT
USEOF DISTRICT NO. GQOUP ]i[ AAP PROCJiMa IST
BUfLDINGf
CoN7RACTOR !Q
ADDRESS CO oN DlLTA
CrrrrKL.ND. srATtion >
ATE MANHOLE,RI9IZRi ICI lung
REGISTRATION N0. COUNTY /
Na R FEE
�Io�ferEcONNECrING TO
00 TYPE OF CONNECTION I.ENQTH FAO■
SEPTIC TANK,SEEPAGE IT OR T. CURB P ■.L TO P
ITS AND OR DRAINFIE _
OVERFLOY/SEEPAGE FIT DRAINFISLD
L. D
HOUSE EWEO CONNECTI G TO P.C.NO.
P�'pRI X CO. INP.N0. JOB NO. � -
JORK C HOUSE>3E R LOG.OR 51.M TRUNK PERMIT N0. )WOAD PEItNIT!10.
T PAI WR ABAN N HOUSE STATtt ENCROACHMENT
ER MIT N0, r
INDUSTRIAL
Vlr APPROY
CHARD
OWNE" PERMIT 00 CONNECTION CHAQGETM
AUTHOMATION1 TOTAL FEE REIYBu118EYEllT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- n
TRACTOR TO CONNECT THE ABOVE DESCRIBED _M"ING DWELLINQ APPROVAIS DATE INSP STOR'S SIGPLAT >zM
TO THE PUBLIC SEVER.
SIGNED THIS SAY OF 19- NEW HOUSE SEWER ��` ✓t'• "
OWNER OR CON ECT ADDITIONAL -
OWNERS AGBUILDING OR WORK
ADDRESS A%MC T K,SEEP.PIT(D)
D/OR DRAINFIELD
1 HEREBT //11CISNOWLEDGE PRAT I HAVE READ THIS AFPL]CATION
AND PTATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CEaSPOOL DRYWEL
WITH ALL COUNTT ORDINAHClS AND STATE LAWS REGULATING ALTER,REPAIR,SSW/EROR.
PLURBING AND SEW1 S. SEWAGE DISPOSAL STMIR
I HER£BT CERTIFY THAT I AN PROPERLY REGISTERID AND/OR DISCONNECT PLUGAND
LICENSED AS REQUIRED ST LOS ANGELES COUNTT AND STATE OF ABANDON HOUSE S6WIER '
CALIFORNIA Oft THAT I A LE OF ABOVE
DESCRIBED REDID BACKFILLsr C TANKS
SIGNATURE SETiP.PITS C[SSPOOU
OF PERYI
m+ VALIDATION ROBERT A. WOOD
L 0. CASE SUPBEtVLSING JARCH NICAL ENOINMM
C 3 0 " "ll 3 i L' D 5 1 3