HomeMy Public PortalAbout4831 CLOVERLY AVE_Sewer__ A
CEa088 as APPLICATION FOR PERMIT
a COUNTY OF LOS ANGELES
, SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
ADDRESS
JOHN A. LAMBIE County Engineer
CASSATI D GRIFFIN. Sup t of Building LOCALITY
NEAREST `
FOFLOT
7AMPPILICALMN TO F;U CROSS SOWNE
MAIL
ADDRE
NO OF BLDGS
NOW ON LOT CITY TEL NO
USE OFTaMMi
BUILDINGS ; DISTRICT NO GROUP BK MAP PROCESSED BY
P6
CONTRACTO /
ADDRESS' CO CTION-DATA
z 21i
CITY TEL NO STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO COUNTY
NO DESCRIPTION OF WORK FEE
t HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q$3 00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR CURB P L M L TO P L
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM $1 00 CO IMP NO _ JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT N ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM 1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS
PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER / 7—
SIGNED THIS OF _19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANG LES COUN AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR TH AM E 0 OF E ABOVE
DESCRIBED RESID R BACKFILL SEPTIC TANKS❑_
SIGNATURE
+ GA SEEP PIT S ❑ CESSPOOLS❑
OF PERM ITTE _
®r VALIDATION-- ROBERT A WOOD
F pK, Is po cmg SUPER smG MECHANICAL ENG)1NEER
_T^8 2 1 2,°`,_ NOV ?7 1 0 A 5.0 0