HomeMy Public PortalAbout4852 CLOVERLY AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEDER-SEV!//4GE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
n COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER j I gU i L D I N GADDRESS 4
< FOR APPLICANT" FOR APPLICANT TO FI L IN LOCALITY
BUILDING rj`��- � d � NEAREST
ADDRESS i:�I .{r(�(/�� ICA4 CROSS ST
LOCALITY Q DISTRICT NO SERIAL NO PERMIT NO
S
NO C
NEAREST t A a /
CROSS ST — '—
��yy RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL �/ ` _
ADDRESS V �► �� { USE ZONE OCCUPANCY / BK MAP PO
CITY TEL NO (� y t / I I L—
r
CONTRACTOR CO.IMP NO 4)4I�
ADDRESS /. �� ?� �� A, JOB.NO
CITY
cccCJ'1..4��� / ,�iTE/L�NO 2,,6, �p�a�� TRUNK PERMIT NO
1le1!_�--- �TU�Y� ROAD PERMIT NO
REGISTRATION NO � -
LEGAL �, PTATE ERMIT NOROACHMENT
DESCRIPTION LOT NO
BLOCK TRACT USTRIAL
WASTE APPROVAL
i
SIZE OF LOT NO OF BLDGS /7
NOW ON LOT CHARGES
/'
USE DCONNECTION CHARGE FEE
BUILDINGS
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOREIMBURSEMENT FEE
PUBLIC SEWER @ $ 350 �'' RECEIPT NO I UA-PEE 113Y
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION kECORDE6
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO I DAT I BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER w -
AND/OR DISPOSAL SYSTEM 1 00 '. CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD - 200 STATION �f C) �, DEPTH `
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY ti 200 MANHOLEEREFERENCE� J
/LOWER
TYPE OF CONN CTON LENGTH FROM
OWNERS PERMIT $ CURB
M L TO P L
AUTHORIZATION TOTAL FEE IHAVE
CONTRACTOR TO CONNECT THE ABOVE D SCRIBEDDAiE CONTRACTED WITH THE I EXISTING ED
APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THI ,.,, -DAY OF _ _ _ _ 1915 NEW HOUSE SEWER
OWNER ORy 1 CONNECT ADDITIONAL
OWNERS AGENT d _ _ _ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
CA
TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS I ALTER REPAIR,SEWER OR
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 D,�E��SyyCRIBED RE IDENTIAL PROPERTY BACKFILL SEPTIC TANKS�`
SIGNATURE �f// p� SEEP PIT(S)� CESSPOOLS[-]
OF PERMITTEE •?6
76A642A 663 ^7/53 �,� �' �� /) )e