HomeMy Public PortalAbout6154 CAMELLIA AVE_Sewer__ .)EPAIrrn[ENT OF 00117s Y l2NGUUMM SEWER---,SEWAGE DISPOSAL 1
.DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
.. .� OOU= OF 1,08 ANGEL
WILLIAM J. FOX, COUNTY ENDINKER BUILDING *�
ADDRESS
FOR APPLICANT TO FILL IN LOCAL
BUILDINGNEAREST
ADDRESS6?1 CR08S ST.
LOCALITY DISTRICT NO. A SERIAL NO. PERMIT NO.
1:7NEAREST /� � �1 r� �?Z
CROSS ST. (� / ECEIVED BY Raab for lupWIsm DA_TEE ISSUED
OWNERAIL
T
AD RE88 �117d �. �[��/j f C _ UBE 20N OCCUPANCY BK KAPP9
CITY ;—` TEL.0.
CONTRACTORYPrNo_ P, c
,f
ADDRESS JOE-N0, r
CITY—rp-weq
TELN0. Q- TRUNK PERMIT R0.
REGISTRATION NO. /r�SS� // AUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT �933� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTX � NOW ON LOT0. CHAROE8
USE
BUILDINGS y / CONN CHARD[FEE
C w���
NO. DESCRIPTION OF WORK FEE
14OUSE SEWER OON)IECTINQ TO REIMBURSEMENT F
PUBLIOSEWER 3.64 RECEIPT NO. E BY
HOUSE SEWER roNNEOTINGTO
PRIVATE DISPOSAL SYSTEM IAO
MM AL BL 8.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1!4
ALTER OR REPAIR EXISTINGNO' DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIO TANK,SEEPAB PIT OR
PITS AND OR DRAINFIELD 2.00 E" nom 1 Q DEPTH
,CE88POOL—D LL
SPECIAL OONDITION6ONLY 2.00 Y UP ERENCE
22 .cTYPE OF CONNEOTI LENGTH FROM
-Gum Y.L.TO P.L
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FSE Vi sy
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 1q_ NEW HOUSE SEWER 4L
OWNEfl OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TAN
K SEEP.PIT(8)
ADDRESS AMD OR DBA NFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 ORYWELL
CATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCE AND STATE LAWS ALTEpREPAIR SEWER OR
REGULATING PLUMBING AND SEWERS. 8EWA6E DISPOSAL SYSTEM
I HERE By
THAT I All PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSESEWER
ER OF THE ABOVE DEILORIBED RESIDENTIAL PROPERTY. BXdRFTIl&E"10'rAWU❑
/� SfiEP.PIT(3)� OE66POOL6
SIGNRE E
RE 2/ �
OF PERYITTE
T6A643A 663 T/63 /