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Home My Public Portal About6138 CAMELLIA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY G/ ?�5j PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDINI j "'WILLIAM J. FOX, COUNTY ENGINEER ADDRESS'!,'^ FOR APPLICANT TO FILL I LOCALITY BUILDING NEAREST ADDRESS CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. C NEAREST A S CROSS ST. RECEIVED BY Ready for Inspection I DATE ISSUED MAILOWNER, � Q� ADDRESS u �. �y USEZONE OCCUPANCY MAP �J �7�-/7 d I BK PG CITY � TEL.NO./T•� / :Vr CONTRACTOR j 1 - ADDRESS JOB NO. CITY J �J yr TEL.NO. ©•, TRUNK PERMIT NO. STATE REGISTRATION NO. �'. Y GYM++ ROADERI'dl P T NO. LEGALSTATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT NO. BLOCK TRACT /5�2' WASTSE APPROVAL SIZE OF LOT NO.OF BL IS CHARGES NOW ON LOT NO. USE OF BUILDINGSCONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR �- EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 NO. —ALTER OR REPAIR EXISTING DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER LOWER _ TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L. AUTHORIZATION I TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER yy� C SIGNED THIS._:_..........DAY OF..... ..___.._...19c� NEW HOUSE SEWER OWNER OR � CONNECT ADDITIONAL � �� CJ�D sJI BUILDING OR WORK _ of OWNERS AGENT. -• "`Y` - ! --...._ -`-••------- ---- (d/ �e_e_ c'-<...... •. AND/OR DRAINFIELD PIT(S) SEPTIC TANKSEEP. ADDRESS.....- --._.. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL E] DRYWELL CATION AND STATE THAT THE ABOVE IS 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 CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT i AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE i� - ` SEEP.PIT(S)E] CESSPOOLS OF PERMITTEE-- -- ----...--.-.. .......... 76A642A 663 7/53