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HomeMy Public PortalAbout6152 CAMELLIA AVE_Sewer__ DEPARTNIENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION + COUNTY OF LOS ANGELES I BUILDING ' WILLIAM J. FOX, COUNTY ENGINEER ADDRESS FOR APPLICANT TO ILL IN LOCALITY BUILDING — NEAREST ADDRESS O - CROSS ST. /,q- LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO. NEAREST A /2 6112 cS S CROSS ST. - QECEIVED BY Ready for InspectionATE ISSUED OWNER ;)/,( �, 7—G/, - . MAIL ADDRESS USE ZONE OCCUPANCY BN PG MAP/ I I CITY TEL.NO. /� X CONTRACTOR CO.IMP.NO. ADDRESS7 �y JOB.N0. JS CITY TEL.NO. TRUNK PERMIT NO. REGISTRATION NO. © COUNTY ROAD PERMIT NO. LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT N0. BLOCK ATRACT / 3 WASTE APPROVAL SIZE OF LOT V D NOW 0.OFON BLDLOTGS. NCHARGES USE OF CONNE ON CHARGE FEE BUILDINGS NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEM FEE PUBLICSEWER 0 $ 3.50 RECEIPT NO. DATE IBY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECO WORK TO HOUSE SEWER 1.00 _ ALTER OR REPAIR EXISTING NO 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 F / PITS AND/OR DRAINFIELD 2.00 STATION / �" DEPTH Cv CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 f/�G MANUHOLE PPERWERENCE TYPE OF CONNECTI LENGTH FROM f Y. CURB P.L. M.L.TO P.L. S�t OWNERS I PERMIT ; 1 00 AUTHORIZATION TOTAL FEE I A -- 1 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 SIGNED THIS--------------------DAY OF..--.._....-._.__.-...._.-......19...... NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT--------------------------------------------- BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS--------------- ._......................................................... AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ 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 AND/OR LICENSED AS RERED BY LOS ANGELES COUNTY DISCONNECT PLUG AND AND STATE OF CALIFOR THAT AM THE LEGAL OWN. ABANDON HOUSE SEWER ER OF THE ABOVE DESOWE0 HE7 ERTY. BACKFILL SEPTIC TANKS SIGNATURE 77:--�-Top SEEP.PIT(S)� CESSPOOLSOF PERMITTEE----------- ------•----------...... -._--V)---.....--•---- 76A642A 663 7/53 i