HomeMy Public PortalAbout6140 CAMELLIA AVE_Sewer__ DICPAaxAFEEvT OF OOT NTY Exc02vMM SEWER.—SEWAGE DISPOSAL 1
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' DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF IAS ANGIU
WILLIAM J. FOX, COUNTY ENo1Mt[R ADDRE a
FOR APP<J TO RLL�IN� LOCALITY rr
BUILDING NEAREST
ADDRESS / CROSS ST.
LOCALITY D18TRIOT 0. 'SERIAL MO. PERMIT NO.
NEAREST 6 A Ig $
CR08E 8T.
BEOEIVEQ BY ReLd'for lupwUss DATE ISSUED
OWNER + r 4)
MAIL '
ADDRESS USE ZONE OCQUPAMCY MAP -J
�y BK PO
CITY � TEL M
CONTRACTOR
QO..H1 Rr110.
ADDRESS
JOB-NO.
CITY TELMO. 2v> TRUNK PERMIT NO.
STATE
REGISTRATION NO. DOUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 1 INDUSTRIAL
WASTE APPROVAL
SIZ[OF LOT N0.OF BLDG&
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNE CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT F
HOUSE SEWER OO NECTIM 0
PUBLIO SEWER &N RECEIPT N0. BY
HOUSE SEWER CONNEOTINo
PRIVATE DISPOSAL SYSTEM Imi
ADD I 6 N BL -G—.o-YF—
WORK
.0 PTIOM RE DED
WORK TO HOUSE SEWER 1.10 c.c�'
ALTER OR hLIPAIR (STING DATE BY
SEWER OR DISPOSAL SYSTEM 1.10
DI 84DO NN CT AM A9AN OM SEWER
AMD ®RT)ISP08AL SYSTEM 1.00 CONNECTION DATA
SEPTAM ,SEEPAGE Pir OR
PITS AND/OR DRAINFIELD 2-00 STATION DEPTH r
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2m AN ��FERENCE
I
LOWER
PE OF CONNECTION LENGTH FROM
OWNERS PERMIT I 00
Y. CURB P.L M.L TO P.L
;
AUTHORIZATION TOTAL FEE a Q
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOV DESCRIBED EXISTING APPROVALS INSPECTO"SIGNATURE DATE
DWELLING TO TH P401-11O
BLIO SEWER
SIGNED THIS DAY OF I �] NEW HOUSE SEWER
OWNER OR &4�� CONNECT ADDITIONAL
OWNERS ADEN BUILDING OR WORK
SEPTIC TAN SEEP.PIT(8)
ADDRESS AND/OR
AND OR DRA NFAELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLY- OESSPOOL[] DRYWELL
DATION AND STATE THAT THE ABOVE IE CORRECT AND AGREE
TO COMPLY WITHALL COUNTY ORDINANCES AND 8TAT[ LAWS ALTER REPAIR,MWER OR
REGULATING PLUMBING AND SEWER& SEWA4E DISPOW,SYST[M
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY D180ONNEOT PLUG AND
AND STATE OF CALIFORNIA OR THAT IAN THE LEGAL OWN. ABANDON HOUSE i[WER
ER OF THE ABOVE DESCRIBED BMD[NTIAL PROPERTY.
SIGNATURE []
i[EP.PIT(S)[] 0[EiP00L8
OF PERMITTEE
T0A"ID M 1/63 r
DEPARTMENT OF COUNTY ENGI2qE1rR SEW Rrr—SEWAGE DISPOSAL 1
"'DIVISION OF BUILDING AND SAFETY � G d PERMIT APPLICATION
COUNTY OF LOS ANGEL
/ WILLIAM J. FOX, CouNTY ENGINEER BUILDING
ADDRESS
FOR APPIJCA TO RLL IN LOCALITY-----7' ,
A D D R
BUILDING /, CRO Bi ST.
LOOALITY' - lJT01BTRI` I 0. A SEMAL NO. PERMIT NO.
NEAREST /� J�
CR088$T Com( `! RECE E
OWNER D BY Ready far lor}�otloc DATE ISSUED
' �N C
YAI� USE ¢ OCCUPANCY MAP
ADBRES8 �� BK PQ
CITY TELN0. a
CO R T RAOTO r/
TEBmm. 6
ADDRESS y JOB.NO.
40=-
orTY;F2,V T[LMO. Q��/ TRUNK PERMIT NO.
STATE
REGISTRATION
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL // STATE ENCROACHMENT
DESCRIPTION LOT NO. (O PERMIT NO.
BLOCK TRACT /93 INDUSTRIAL
WASTE APPROVAL
0.812E OF LOT o X yea NOW OFONLOOTL CHARGES
USE OF
BUILDINGS CONNEOTI ARG FEE
NO. DEBCRIPTION QF WORK FE[
REIMBURSEMENT FEE
UB 8 ER 00 Y 0
PUBLIC SEWER &m RECEIPT N0. BY
HOUSER DO
PR VATEB D SPOSALBYSTEM 0 Im
GONNIZOT ADD B EXCEPTION RECORDED
WORK TO-HOUSE SEWER I.M
ALTER OR REPA STI Q NO' DAT[ 8Y'
SEWER OR DISPOSAL SYSTEM Im
ISCON ECT AND ABANDON SEWER
AND ORDISP08ALSY EY 1.09 CONNECTION DATA
PITS AND/ORDRA NFIELD OR
LH STATIOIiDEPTH
POOL--DRYWELL ot
BPECIAL CONDITIONS ONLY LM I MAN REFERENCE
IS
�ptLOW
TYPE OF CONNECT( P"L LENGTH
FROM
OWNERS PERMIT ; I 00
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAM[DI
CONTRACTOR TO CONNECT THE ABOVE DESCIUBED ®CI—nNQ1 APPROVALS INSPECTORSSIGNATUR¢ DATE
LI
DWELLING TO THE PUBO 8[WER
SIGNED THIS nAY OF 19_ MEW HOUSE SEWER OWNER OR F
CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
8EPTI0 TANK SEEP.PIT(S)
ADDRESS ! AND/OR DRA NFI[LD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CEWOOL[] DRYWELL E3CATION AND STATE THAT THE ABOVE IS OORREOT AND AGREE
O CON PLY GWALLPLUMBING AND COUNTY AND STAT[ LAWS ALTER REPAIR.SEWER OR
SEWA�E DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM ROPERLYAMD/OB LIOENSED AS REQ IRED BYPLOS ANGELES REQ(COUNTY.
DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOU8E8EWER
ER OF THE ABOVE BED REIND IMAL PROPERTY. []
dEEP.PIT(S) OfiESP00L8
SIGNATURE
OF PERYI
TU442A GM T/6.1 C1�