HomeMy Public PortalAbout4824 CLOVERLY AVE_Sewer__ DEPAWrMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
, ,'DIVISION DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
r COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENt3INEER I BUILDING <
ADDRESS
FOR APPLICANT TO ILL IN LOCALITY
BUILDINGNEARES
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ADDRESS CROSS ST. ?�
LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO.� r if
NEAREST f
CROSS ST. A /S?
/C5) �.
BEC IVED Ready for Inspection DATjEISSUgD _
OWNER ✓` ' / PS ,
MAIL
ADDRESS .eaQ�sa.an U5E-ZO N0' OCCUPANCY MAP G
BK
CITY TELAO.
CONSRACTOR CO.IMP.NO. /`7% /
SEPTIC TANK SERVICE
ADDRESS -
E. _ - 1 `. y JOB N0.
CITY TEL.NO.
TRUNK PERMIT NO.STATE
REGISTRATION NO. D��� COUNTY
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ROAD PERMIT NU. 2 � `c
LEGAL 3
DESCRIPTION LOT NO. I STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT /� �� INDUSTRIAL —
r 1 WASTE APPROVAL
SIZE OF LOT �Q NOW ON LOTS G� CHARGES
J
USE OF �
BUILDINGS In CONNECTION CHARGE EE
N0. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER Q S 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO I/
PRIVATE DISPOSAL SYSTEM 1.00 /
CONNECT ADDITIONAL BLDG.OR ryG1 EXCEPTIO RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING / NO* I D TE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM LDO CONNECTION DATA ,y
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION � � , DEPTH �
CESSPOOL—DRYW ELL _
SPECIAL CONDITIONS ONLY 2.00 MANHOLEREFERENCE LOWER
TYPE OF CO ECTION_ LENGTH FROM
OWNERS PERMIT ; I 00 ` cuR6 tp°t?, M.L'.TO P.L. 'j.
AUTHORIZATION I TOTAL FEE 9
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
7- F_
SIGNED THIS....�_ .____-DAY O _ .........._.._......19 NEW HOUSE SEWER
1 �'7 ��.•�
OWNER OR T // �� /xv BUILDING OR WORK OWNERS AGE T/--rr�-`.__e ���-�--```�-`-L-;----
�� j� SEPTIC TANK.SEEP.PIT(S)
ADDRESS_._ �......_......._.. _ w..,_._ _._y4. .�..... .. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL(] DRYWELL C]CA NON AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 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 DE IBEDRESIDENTIAL PROPERTY'^ BACKFILL SEPTIC TANKS
/ SEEP.PIT(S) CESSPOOLS � cr
SIGNATURE ✓
OF PERMITTEE L'.,.eee_—L_:—. __.• �t�_ z..__.
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