HomeMy Public PortalAbout4526 CLOVERLY AVE_Sewer__ l
APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
.Dsparft-at of Ca—t7 Fauhum
C=31T of Los Anuelm BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER AD°RAS
m CAS8ATT D.GRIFFIN, SU"OF BUILDING - LOC
ARXffT NZ
FOR APPLICANT TO FILL IN N Oss
LEGAL OWNER
DESCRIPTION LOT NO.
[AIL
BLOCK TBACT ADDRI S i
_ NO.OF BLDGS. CITY TE1.. N0. 2 S
SIZE OF LOT NOW ON LOT
USE OF DISTRICT R0. GROUP MAP
BUILDINGS
B[ P
cbNTItACTOB 91
CONNECTION DllTA
ADDRESS ,
1
fTATION O DTPTH
CITT TQM. N0. MANHOLE RUMtEXCE / � Upruo
STATE
REGISTRATION NO. COUNTY
No, DESCRIPTION OF WORE( FEE TYpg OF ION LENGTH FROM
HOUSE SEWER CONNECTING TO U
PUBLIC SEWER 0 S 3.50 RS Y.L.TO P.L.
SEPTIC TAMC,SEEPAGE PIT OR
PITS AND/OR PRAINFIELD Q S 3.00
OVERFLOW SEEPAGEPIT,QRAINFIELD F, C. R0.
i
EXTN.,CESS OL DR ELL MANHOLE 2.00 CO. IIP. NO. JOB R0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 TRUNK PERMIT MO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER 31.00 O o PERMIT MO.
ALTER,REPAIR OR ABANDON HOUSE
SEINER OR DISPOSAL SYSTEM 1.00 INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CRARGC FEE.
Ovim'S PmbaT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
1 HAYE AT THISDATE A CONTRACT WITH THE HEREIN NAMED CON- APPEOVALS DATE INIVAffll�GJIJATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEYIER IL H
�-y. LN EW SEVER
SIGNED THIS OF 19TL CONNECT ADDITIONAL
OWNER OR BUILDING OR ORI[
OWNERS AGENT SEPTIC TANK,SEEP,PIT(8)
ADDR AND/OR DRAINFIELD
1 HEREBY.ACKNOWLEDGE THAT 1 HAVE 6rE.AD THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL CQUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
LICENSEDBASCERTIFY REQU REQUAT I IRED LOSMANGELES PROPERLY
COUNGI ED AND STA`IE�F DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 THE LEG 0 OF THE VE ABANDON HOUSE SEWER
DESCRIBED R DENTIA OPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(3) ❑ CESSPOOLS El
OF PERM) - _
JOHN A. LAMBIE. C ENa1t4EER ATION ROBERT A.WOOD, CNIMF PLI5G. INSPECTOR
+! CK. Y.o. �®
- - 'LACo4 33 6G�, Ncvl 5 4 550
6