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Home My Public Portal About4850 CLOVERLY AVE_Sewer__ r` C E608 10-63 76A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPO AL (J DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS WILLIAM A JENSEN Sup t of Building L OCAL,TY NEAREST FOR APPLICANT TO FILL IN `ROSS 5T LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT y ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY l r TEL NO US E 0F BUILDINGSDISTRICT NO GROUPJ MAP PROCESSED BY 1 r BK PG CONTRACTOR /r, � A D D R Es l CONNECTIONGAI (/ CITY TEL NO AT ON D PTH STATE MANHOLE REFERENCE J lop UPPER REGISTRATION NO �, J, COUNTY L m_wwrw N DESCRIPTION OF WORK FEE TYPE OFC NEC 10 LEN H FROM HOUSE SEWER CONNECTING TO Y R ML TOPIL PUBLIC SEWER @ $5 00 P C NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO O PITS AN D/OR DRCA INFIELD @ $1000 �J V HOUSE SEWER ONNECTING TO TRUNK PERMIT NO ROAD PERMITN C/� i[ PRIVATE DISPOSAL SYSTEM @ 5300 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER E4SEME9T RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD {!J EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 a ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h SEWER OR DISPOSAL SYSTEM @ S300 STATEENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S 2 00 CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST NG DWEL ING TO THE PUBLIC SEWER r APPROVALS DATE INSPEC R S'S TIATURE SIGNED THIS AY OF 46 — 1 -�v OWNER OR NEW HOUSE SEWER p OWNERS AGENT CONNECT ADDITIONAL yn� ADDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(5) I HFREBY ACKNOWLEDGE T T I HAVE READ HIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOV IS CORRECT AN AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REOUIR D BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THA THE LEGAL OWNER O AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE VE SCRIBED RE DENTI L ROPERTY ABANDON HOUSE SEWER SIGNATURE I1 _ BACKFILL SEPTIC TANKS El PERMITT �/\� ❑ SEEP PIT(5) ❑ CESSPOOLS VALIDATI` ROBERT A WOOD C SUPERVISING MECHANICAL ENGINEER CK M O CASH LA600859% MR 291 0 A 7.00- Q i D S&11 663 D DD APPLICATION FOR PERIVII`i' ESa 1 8&H 8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D i S POSA L Department of County Engineer County of Los Angeles BUILDING WM J FOX, COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER C BLOCK TRACT MAIL ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO ! USE OF •A BUILDINGS DIT NO GROUP I MAP �+ �+ BK PG CONTRACTOR * .�Q�i/' L_ ADDRESS ,r f .S� CONNECTION DATA �O&-V!60® CITY TEL NO STATION � DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO It) 9, �? ❑ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE ECTION LENGTH FROM/ PUBLIC SEWER Q $ 3 50 �� CURB M L TO P L (Q HOUSE SEWER CONNECTING TO �— PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR 1 L�/� PO OB NO WOR, TO HOUSE SEWER 1 00 CO IMP NO / / ALTER OR REPAIR EXISTING TRUNK PERMIT NO ROAD PERMIT NO ro d 6 �j //I SEWER OR DISPOSAL SYSTEM 1 00 R-6/-- DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 00 PERMIT NO SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINFIELD 00 INDUSTRIAL CESSPOOL-DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 5 1 00 AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE TRACTORHAVE iTOS CONNECTDATE ONTRTHEAABOVECTED WDESCR BEDITH THE YEREIEXIISTIINGNAMED DWELLIING CON APPROVALS D TE INSPECTO4 SSIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 1 NEW HOUSE SEWER ' A OWNER OR '�"` CONNECT ADDITIONAL OWNERS AG EN BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAV EAD THIS APPLICATION CESSPOOL[3DRYWELL❑ 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 CE / LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF-THE ABO4E ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS f / SEEP PIT(S) ❑ CESSPOOLS❑ SIGNATURE OF PERMITTEE WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R A WOOD, CHIEF PLBG INSPECTOR 110`76oin JUL 3 4 4.5 0 r A s f C � V CE808 10-63 76A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS f' WILLIAM A JENSEN Sup t of Building LOCALITY �� NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNE I' MAIL BLOCK TRACT ADD NO OF BLDGS SIZE OF LOT NOW ON LOT CITY i TEL NO USE OF DISTRICT NO GROUP MAP ZPRSSED BYBUILDING ( I qq BK �yPG CONTRA ADDRESS CCONNECTION DATA TATION L EPTH CITY TEL N 7 ) �, ❑ STATE MANHOLE REFERENCE Wit' UPPER REGISTRATION NO ❑ COUNTY +140WER NO GESCRIPTIO OF WORK FEE TYPE CO NEGTION LENGTH ROM HOUSE SEWER CONNECTING TO Y U ') P L M L TO P L PUBLIC SEWER Q E5 00 P C NO a SEPTIC TANK SEEPAGE PIT OR CO IMP NO p JOB NO O PITS AND/OR DRAINFIELD $1000 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO� O PRIVATE DISPOSAL SYSTEM @ $300 I=CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIVEX EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ 5300 F" OVERFLOW SEEPAGE PIT DRAINFIELD ll.1 EXTN CESS OL DRYWELL MANHOLE @ $5 00 ALTER R AIR OR ABAND HOUSE HWY OR ST WIDENING N SEWE DISP SAL,2Y M @ $3 00 STATE ENCROACHMENT / PERMIT NO /�--� INDUSTRIAL WASTE APPROVAL OWNERS PERMITs CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBE (1 TING DWEL N APPROVALS TO THE PUBLIC SEWER DATE INSP CTOR 5 SIGN URE SIGNED THIS DAY OF 9_ OWNER OR ��, NEW HOUSE SEWER J" OWNERS AG T 111 CONNECT ADDITIONAL ADDRESS BUILDING OR WORK ✓ SEPTIC TANK SEEP PIT(S) t 1 HEREBY ACKNOWLEDGE HAT I HAVE AD THIS APPLICATION AND/OR DRAINFIELD { AND STATE THAT THE AB E IS CORREC AND AGREE TO COMPLY WITH ALL COUNTY OR NANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY TIF T T I AM PROPERLY REGISTER D AND/OR ALTER REPAIR SEWER OR eft LICENSED RE IRED Y LOS ANGGL`'ESS COUNT A STATE OF SEWAGE DISPOSAL SYSTEM llfl CA LIFOR A OR AT I THE LEGAL pyrtvER O A D INTEND TO DISCONNECT PLUG AND RESIDE I TH ABOVE ESCRIBED R NTI PERTY ABANDON HOUSE SEWER SIGNATU 1 � FILL SEPTIC TANKS 11OF PERM1 SEEP PIT(S) F-1CESSPOOLS ❑ VALIDATI ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH LkoQ858zZos MAR 219^ 11 A 25.00 V�