HomeMy Public PortalAbout6142 & 6144 CAMELLIA AVE_Sewer__ DEPATtTNIMNT OF OOUNTY EN(RNffii SEWER-SEWAGE DISPOSAL 1
DIVISION OF s>E.DING AND SAFETY PERMIT APPLICATION
OOUNTY OF WS ANGET
WILLIAM J. FOX, CDUIIZY ENGIIN[[R BUILDING G f� �` CM3 tY1-A 1I I8. r
ADDRESS
. _ LoALIFOR APPLICAMO RLL IN
BUILNEAREST
GSADORE —mm ST.
T.
LOCALITY DISTRICT NO. A SERIAL 110. PERMIT NO.
NEAREST //'� A ...
CROW ST. ECEIVED BY RuLdy f Iupeouaa DATE ISSUED
OWNER
■AISZ 70 L� my� � UaH ZON OOOUPANQY eK MAP ra
AAIL /
STY TKLNO. s 1
CONTRAOTOB _/ / .SGr-F�If
ADDRESS >' 49 JOS-NO.
CITY lg TELMO. Q TRUNK PERMIT N0.
STATE
REGISTRATION N0. � // COUNTY ROAD PERMIT NO.
LEGAL .y STATE ENCROACHMENT
DESCRIPTION LOT N0. / PERMIT NO.
BLOCK TRACT 1"9334 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 5-6X'Y� NoOF NLOT CHARGES
USE OF
BUILDINGS DONNE CHARG[FEE
NO. DESCRIPTION DF WORK FEE
HOUSE BEWER N REIMBURSEMENT
PUBLIC SEWER L" RECEIPT NO. ATfi BY
HOUSE ER CONN N TO
PRIVATE DISPOSAL SYMM IJO
WORK TO HOUSE SEWER I,MI EXCEPTION RECO RDE
ALTt R 0 r I h STING NO DATE _ BY
SEWER OR DISPOSAL SYSTEM I.M
ISOONN AND ABANDON tEVIER
AND/OR DISPOSAL SYSTEM I.OS CONNECTION DATA
SEPTIC TANK,BEErAGE PIT OR
PITS AND/OR DRAINFIELD 2.65 STATION DEM
ESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2J4ANHOLE REFEBENOE
L
TYPE OF CONMECTI
nLENGTH FROM
. r.L LEN P.L.
T
OWNERS PE;LMrT ; I 00 MA-
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
DONTRAOTOR TO CONNECT THE ABOVE DESONIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DAT[
DWELLING TO THE rUBLIO SEWER
SIGNED THIS DAY OF Iq— NEW Hous[SEWER a
OWNER ON CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK.S[HP.PITO
ADDRESS AND OB DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A"Ll- CESSPOOL[] DRYWELL E]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANOES AND STAT[ LAWS ALTER.REPAIR,BEW[R OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
AMD/OR LICK
0[NSEHEREBY DnAS REQUIRED BYFY THAT IrLOS ANGE ROPERLY ESGlSTE 000NTY
DISCONNECT PLUG AND
AND STAT[ OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN- ABANDON HOUSESKWER
ER OF THE ABOVE DESC
RIBED RESIDENTIAL PROPERTY. AN
ATU []
SIGNRE ,[ SEEP.PIT(S)Q CESSPOOLS El
OF REREITT /
E Z
TeASU MM 7/63 I 1