HomeMy Public PortalAbout6145 CAMELLIA AVE_Sewer__ DXPAICrKENT OF OOUNTY ENc#INIKIM SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGFffT TLR
WILLIAM J. FOX, CouwrY ENCIIH[ER BUILDING
ADDRESS C,
FOR APPLICANT TO RLL IN LOCALITY C
BUILDING / �'�/ ^ NEAREST
ADDRE88 ( OR08Y8T.
LOCALITY � � /� DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST (/1� A 1II
A
CROSS ST. EOEIVED BY Rtady for Imapset!w DATE 18WED
OWNER �Y� ,
MAIL USE ZO OCCUPANCY YAP
ADDRESS G ,(J BK P9
CITY TELMO - - <-
CONTRACTOR +Tj c 1 } 1
ADDRESS JOB NO. - , 1 R
1`4'
no
CITY TELNO. Q-371' TRUNK PERMIT NO.
STATE
REGISTRATION NO. / �I � J/�1/ COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DEBORIPTION LOT NO. jl PERMIT NO. -------�
BLOCK TRACT r933� INDUSTRIAL
WASTE APPROVAL
81ZE OF LOT X�6d NOW ON LONO.OF T' CHARGES
USE OF `��l���
BUILDINGS OOYNEOTI HARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT
PUBL10SEWER • III L50 RECEIPT NO. BY
H 0 US EWER CO
PRIVATE DISPOSAL SYYTEM LN
CONNECT ADDITIONAL BL S.OB EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIRI IN NO- DATES BY
SEWER OR DISPOSAL SYSTEM 1A9
DISOONNEOT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM LOO CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT
PITS AND OR DRAINFIELD R 2.00 YTATION 4EPTH
OESSPO L--0RYW L
SPEOIAL CONDITIONS ONLY 2.00 1 lln gllNH LE pEFERENCE
LOW
TYPE OF OONNECTI LENGTH FROM
OWNERS PEFLMrT ; 00 M.L.TO P.L
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREI
DONTRAOTOR TO OONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTO"SIGNATURE DATE
DWELLING TO THE PUBLIO BEWEB
SIGNED THIS DAY OF 19— NEW HOUSE SEWER �^
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,BEEP.PIT(8)
AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[:] DRYWELL E]
CATIONAND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO DOYPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR�BEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPO LSYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AND/OR LICEBED AS REQUIRED BY L08 ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AY THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESORIBED RESIDENTIAL PROPERTY. L IC TAN []
SIGNATURE SEEP.PIT(S)E] CEWPOOLY E]
OF PERMITT
TSA.&LU E63.7/6a 1/ til