HomeMy Public PortalAbout4807 CLOVERLY AVE_Sewer__ _ I
DEPAktiVAMNT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY Jr 6 PERMIT APPLICATION ---
_ r COUNTY OF LOS ANGELES
(t WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT jp FILL I LOCALITY -
BUILDING NEAREST
ADDRESS CROSS ST
LOCALITY l� DISTRICT NO A SERIAL NO PERMIT NO
A
NEAREST J 5 -- - /36,"/7 s
CROSS ST ef, rI
RECEIVED BY Ready for Inspection— DATE ISSUED
OWNER b-ell
-,5-53
MAIL � � � /�� USE ZONE OCCUPANCY MAP
ADDRESS ..,.CJtJfAIA, BK PG
CITY��, (�O TEL NO
CONTRACTOR yC0 IMP NO lyA�p —
ADDRESS Q 419- I
JOB NO
CITY TEL N
leleft_' TRUNK PERMIT NO
/r STATE
REGISTRATION NO l 3 C. TY ROAD PERMIT NO 2250 Q A14
LEGAL (" /O p
DESCRIPTION LOT NO c] , STATE ENCROACHMENT
_ PERMIT NO
BLOCK TRACT ZJ INDUSTRIAL
-7e' NO NO OF BLDGS i WASTE APPROVAL
�
SIZE OF LOT lQO �C eNOW ON LOT CHARGES
USE OF
BUILDINGS 4C dLd j CONNECTIO -CH RGE FEE
NO DESCRoPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3 50 RECEIPT NO X DATE\�BY
HOUSE SEWER CONNECTING TO /
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ODDITIONAL BLDG OR' f EXCEPTION RECORDED �1
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING __ _ _ NO I DATE BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR 1
PITS(AND/ORDRAINFIELD 200 I STATION /f 31� Q DEPTH 6a
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 I � MANHOLEREFERENCE
- I 6 �pi
/y A LOWER
TYPE OF CONNECTION LENGTH FROM f
OWNERS PERMIT $ I 00 Y CURB I/ P L — ML TO P L 57/2t
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT-THE ABOVE DESCRIBED EXISTING APPROVALS IUSP ECTOR'SSIGNATURE DATE
DWELLING TO T�HE� PUBLIC SEWER
SIGNED THIS y` �ZCDJAY OF � j l9 _�� NEW HOUSE SEWEROWNER OR COECT
OWNERS -AGENT
/ //// ,�S�i_' �^ � � BUILDING OROWORKAL
ADDRESS �`V 7 (le-4/ SEPTIC TANK SEEP PIT(S)
' AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVEIREAD THIS APPLI. CESSPOOL[:] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT-PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
/J d SEEP PIT(S)[:] CESSPOOLS❑j e--�'�h �'�Odf�
SIGNATURE
OF PER
70A642D 663 1/53 i