HomeMy Public PortalAbout4502 CLOVERLY AVE_Sewer__ ,I
8A"0a la-e4 APPLICATION FOR PERMIT
- •a 4} 1
M9MON OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSH L
D.pGtt.a o3 C —ty >nQFbaw
COlmty of Los AnQelws 7UILD1■O
WM.J. FOX. COUNW ENGINOM DR86S
CA MATT 0.GRIFFIN.=U*'T of Wutunms LOCALITY
FOR APPLICANT TO IN Nwlaff
oS3 ST
L[GAL
D"(M ION LOT NO OWKp
SLOCI TRACT NAIL
A"DDEm 7 �
N0.OF BLOTS.
SIZE OFLOT K0W OR LOT TIL. Ivo
USE OF
BUILDINGS DISTRICT N0. on up D[I YAR
PG
CONTRACTOR
ADDRK.59 ,j /:�M C 1 A+ COMU=OH DATA
CITY O— Q YEL. NO. STATION DEPTH
EFER1tKCX
REGISTRATION NO. ❑ COUNTY f0
TYPE ECTI LFlIGTII FROM
MO. DESCRIPTION QF WORK FEE CUR Y.L TO P.L.
1 HOUSE SEINER CONNECTING TO fnt
/ PUBLIC SEWER f 9.50_ V
-HOUSE SEWER COXX CTIIIG TO
PRIVA76 DISPOSAL SYBTEY . _1._00_
CONNECT AI3DITIONAL BLDG. OR CO. INP,NO. V144 JOB. N0.
'WORK 70 HOUSE SEWER 1.00
A TER OR RE AM EXISTING ,
SEWER OR DISPOSAL SY Y 1.00 TRUMIL PERM N0. ROAD PERMIT NO.
D IS COn�(XECT AXD ABA pOK SEWER STATE ENCROACHMENT
AND/011 DISPOSAL SYSTEM 1.00 ERYIT NO
SEPTIC Dr K,SEEPAGE PIT OR INDUSTIt1�L
PITS AN DRAINIIIELD. 2.00
C 9 00 DRYWELL WASTE APPROVAL
SPECIAI.CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNS S P7 s 1 00
AUTHORIZATION TOTAL FEt • aEIYBVRSITYENT FEE
F HAVE THIS D4TE CONYRACTED WITH.THE HEREIN k"ED COR- APPROVALS_ DATE IXSP CTOR S SIGNATURE
:MACTOR TO CONNECT THE ABOVE DESCRIBED FXISTIN4 D�ELI,INp
TH[ PUBLIC 9
SI NEW HOUSE SEWER
SIGNED THI � AY OF � �5
OWII$R Oil toMNEdT ADDITIONAL
OW ERS AGENT BUILDING OR WORK
SEPTIC TANK,,fFXP,FTT(S-)
ADDRESS AND/OR DRAIN IELD
I HEREBY ACQIOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL.❑
AMD STAT$ THAT THE ABOVE IS CORRECT AND AGREE TTpp COMPLY
WITH ALL COUNTY ORDIKAMCES ]UID STATE LAWS R[OULATMO T-R, REFAl,%,Srwn OR
FLUYBIPG AND SEWERS. kTAG[DISPOSAL SYSTIA
I HEREBY CERTIFY THAT I At PROPERLY REGISTERED AND/OR
LIGANp AS REQUIRED pY LAS ANGELES COUNTY AMD STATE OF DISCONN[CT PLUG MID
CALIfbRNIA OR THAT I AN TH['LJIGAL OWNSR OF'THE ABbVE ABANDON HOUSE-SEWER
MRSCRIBRD RESIDKXnAL "OF SACIFILLC TANKS❑
-.
SE. TIS C6 "O
SIGNATOR[
OF FERYIT`Pa
WI�Luwj J. FOX.COUNTY, VALMATMN
ST 12. 4 450
�
D[PUTT IT b pdiu
By ST +
i
.`,m DrPUTY � DEPUTY Y'
. v
COUNTY OF LOS ANGELES TEMPLE CITY f 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TLIM BE 0508 0309030001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER X BUILDING ADDRESS:
TR: 12998 LT: 60 BL: .001 EXIST OCC GRP::
4502 CLOVER-LY AV
- BLDG$. NOW ON LOT: TEMP CA 917804203
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LOWER AZUSA
8592-0027062 ORIGINATION: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
• MANHOLE REFERENCE: UPPER/LOWER: ON:
' COUNTY IMPROVEMENT NUMBER: 09/04/03 JK 03/02/04
OWNER: TEL. NUMBER:PLAN CHECK NUMBER: FI W DATE FINAL BY.:
-
NANEZ44
JOSE ANDRES i PATRICIA RIVAS (626) 485-95 - JOB NUBER:
4502 CLOVERLY.AVE TRUNK PERMIT NUMBER:
TEMPLE CITY 91780 ROAD PERMIT NUMBER: DESCRIPTION OF wusw
AfFADAVIT: NO CONNECT GARAGE TO SEWER LINE
WAIVER: N0
• EASEMENT: NO
SAME AS OWER -
RECORD INSTRUMENT MBR: RECORD DATE:
HIGHWAY/STREET WIDENING:--
STATE
IDENING:_STATE ENCR0ACHMEI(T PERMIT NURBER:
COKTRACTOR: TEL. W: Fft* PAID APPROVALS TE INSPECTOR SIGKATURE
SAME AS OWNER - DA-
LIC. N0 FEE DESCRIPTION: QUANTITY: UKM: AMOUNT: NEW HOUSE SEWER
01 PERMIT bSSUAMCE FEE 27.75
CONNECT ADDITIORKE-
19,CONP ADDTNL BI,DG(S) 1.00 EAC _ 30.45 BUILDING OR WORK
ENGINEER:ARCHITECT OR - - TOTAL FEES 58.20
SEPTIC
SEEPAGE PIT
LIC. NO: AND/OR DRAIN FIELD
DRTWELL
SEWER MAP BOOK: PAGE:
8EWAf REPAIR SEWER OR
DIiPO SYSTEM
— ABANDON HOUSE SEWER
SEEP. PIT CESSPOOL
REPORT ID: DPR266 ROUTE TO BS.0508