HomeMy Public PortalAbout6158 CAMELLIA AVE_Sewer__ D"AS 17 OF OOUNTY EN(32TEER SEWER—SEWAGE DISPOSAL 1
DIVISIOX `OFA BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF 1.08 ANGFIT,>t�
WILLIAM J. FOX, COuNTY ENOIHEnm BUILDING
ADDRESS 8
FOR APPUCANT�O RLL IN LOCALITY �T
BUILDING / yNEAREST
ADORE
ST. �✓�
LOCALITY '�ar�pG C�rTt� DISTRICT N0. SERIAL M0. PERMIT N0.
NEARESTr,� A _S
CROSS ST. f //j f}�,�� �y RE E VED BY Ready for IsapwUcm DAT[ISSUED
OWNER
MAIL AD REBS ��7d �_ ��{/ �. USE E OCCUPANCY ex MAP re
CITY TEL*Goqr7zT7S _
CONTRACTOR {O, r/
ADDRESS l�V�( d JOB.NO. �- Y
CITY -MLNO-/G 6-37/7 TRUNK PERMIT N0.rl STATE
—
REGISTRATION NO. Axlm OOUNTY
ROAD PERMIT M0. �^
LEGAL STATE ENCROACHMENT
_
DESCRIPTION LOT N0. D PERMIT NO.
BLOCK TRACTr INDUSTRIAL —
WASTE APPROVAL
SIZE OF LOTN0.OF RLDQL
NOW ON LOT CHAROEB
USE OF OONNEOTI HARGE FEE
BUILDING6
NO. DEEICRIITrION OF WORK FEE
' HOUSE SEWER ooliliolRoTMG TO
REIMBURSEMENT FE
PUBLIC SEWER • &H RECEIPT NO. ><TE BY
HOUS9 SEWERM IN 0
PRIVATE DISPOSAL SYSTEM Im
COMWA—Lff LUSLE OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.80
ALTER OR REPAIR 1 NG NO- DATE. BY
SEWER OR DISPOSAL SYSTEM 140
DISCONNECT AND ABANDON E■
AMD OR DISPOSAL SYSTEM I" CONNECTION DATA
0 TANK,SEEPAGE PIT OR
PITS AMD OR DRAINFIELD 2.W STATION 2 fs� Q DEPTH
PO L—D ELL r AN EFfiRENCfi
SPfi01AL CONDITIONS ONLY 246
P
TYPE OF CONNECTIe4lpt,, LENGTH FROM
OWNERS PERMIT $ ILC)O
MA_TO P.L. S
AUTHORQATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN MAY ED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIO SEWER-
SIGNED THIS DAY OF Iq_ NEW HOUSE SEWER —
OWNER OR RS
ADDITIONAL
OWNERS AGENT BUILDING ORWORK
SEPT10 TAN SEEP.PIT(8)
ADDRESS AND/OR D NFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- O[SSPOOL[:] DRYWELL I]
CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIRjEWER OR
BEGULATINB PLUMBING AND SEWERS. SEWAGE DISPO L SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AMD/OR LICENSED A8 REQUIRED BY LOS ANGELES COUNTY D1800MNEOT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUBESEWER
ER OF THE ABOVE OPMBED REBID[ AL PROPERTY. BACKFILL SEPTio TANKO
SIGNATURE SEEP.PIT(S)E] CESSPOOLS 0
OF PERMITTEE (�
76ABOA Eea 7/53