HomeMy Public PortalAbout4840 CLOVERLY AVE_Sewer__ E-6D69 11.89
S& � APPLICATION FOR PERMIT
S&E-8
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer 600
h
County of Los Angeles ILDING
ADD ESS. CLOy e r Iy
JOHN A. LAMBIE, COUNTY ENGINEER v
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY �Q, Qi t A
F
OR APPLICANT TO FILL IN
NEAREST. . ver g.a
pP�
ION LOT NO. Z OWNER 1,
TRACT
/e .1y U ADMA IDRESS ® Al.Ch)Tfarly A-me
LOT& � U (�� NO.OF BLDGS. � CIS
P TEL. NO. '°:' p 4 (7*(
.N WON LOT
Q IJQ b eEia GROUP MAP
S
BK 1,0 f—
PG
TOR /,LQ'oCONNECTION DATA
N' STATIONDEPTH
CITY TEL. NO. UPPER
MANHOLE REFERENCE
El STATE
Y REGISTRATION NO. ❑ COUNTY .
e
NO. DESCRIPTION OF WORK FEE
a. TYPE OFCTION LENGTH FROM
HOUSE SEWER CONNECTING TO P.L. M.L.TO P.L.PUBLIC SEWER (� $3.50 it,.d Y- C B
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. NO.
Y
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $ 2.00 CO. IMP. N0. JOB NO.
HOUSE SEWER CONNECTING TO �y
PRIVATE DISPOSAL SYSTEM (t7i $1.00 - TRUNK PERMIT NO. ROAD PERMIT NOA �y d F
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT 1
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
REIMBURSEMENT FEE'
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- ,5 APPROVALS ATE INSPECTOR'SSIG ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING C.
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
" ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �`' CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY `.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING .� ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR a DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF + ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL ROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) [3 CESSPOOLS -
OF PERMITTEEA,1 A_4MA
JOHN A. LAMBIE, CO TY E EERVALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH
LACo 0 6 3 Y:- JUL 2 5 4 4.5 0