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Home My Public Portal About4900 CLOVERLY AVE_Sewer__ 1 10-63 76A642D APPLICATION FOR PERMIT 6A84 �J COUNTY OF LOS ANGELES SEWER-SEWAGE DISP SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING l JOHN A LAMBIE County Engineer ADDRESS /� WILLIAM A JENSEN Sup t of Building � LOCALITY NEAREST FOR APPLICANT TO FILL IN CR055 ST LEGAL /► f [DESCRIPTION LOT NO e '� 1. �.A .Z OWNER +/v7 J OCK TRACT �� MAIL Q �/C40 6)?� ADDRESS 1' /�T ZE OF LOT (' NOW OON LOTS CITY ; .L/� /J ( TEL NO SE OF DISTRICT NO GR MAP P OC ESSED BY UILDINGS BK PG CONTRACTOR �y C / o ADDRESS lLO WFe' Aza-SAn CONNECTION DATA ` ' TEL NO J �7 STATION DEPTH CITY STATE UPPER REGISTRATION NO COUNTY MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER @ 55 00 SEPTIC TANK SEEPAGE PIT OR J C NOOBNO O PITS AND/OR DRAINFIELD @ S10 00 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO w PRIVATE DISPOSAL SYSTEM @ S3 00 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVIR rASEMrNT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ S300 OVERFLOW SEEPAGE PIT DRAINFIELD W EX TN CESSPOOL DRYWELL MANHOLE @ $500 HWY OR ST WIDENING ABANDON HOUSE H SEWER QAjRN@'9$iL SYSTEM $3 00 139 li2ad STATE ENCROACHMENT PERMIT NO INDUSTRIAL i' WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION I TOTAL FEE /}r�1 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBU RSEMENT FEE 1 TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL �• BUILDING OR WORK ADDRESS EIANKIC TANK SEEP PIT(S) v I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGUL PLUMBING AND SEWERS POOL ❑ DRYWELL ❑IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STAAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEONNECT PLUG ANDRESIDE IN THEABOV DESSBEDRES ENTIAL PROPERTYNDONHOUSESEWERSIGNATURE KFILL SEPTIC TANKS ❑OF PERMITTE PITIS) ❑ CESSPOOLS ❑ VALIDATIOI)T/"-\ ROBERT A WOOD CK M o (mac gsSUPERVISING MECHANICAL ENGINEER ,rftllo3 3 2 t1'^ 4 1 0 D Boo- 4 r 10-63 76A642D APPLICATION FOR PERMIT 6A64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS WILLIAM A JENSEN Sup t of Building LOCAL Tr Alf NEAREST FOR APPLICANT TO FILL IN `ROSS ST �rT XAC21, rr Az& LEGAL V DESCRIPTION LOT NO OWNER J,014 MAIL BLOCK TRACT ADDRESS NO OF BLDGS O J�d-r ,f f3 SIZE OF LOT NOW ON LOT CITY TEL Na USE OF BUILDINGS DISTRICT NO ;;GROUPMAP PROCESSED BY BK PG CONTRACTOR / x, ADDRESS ' - CONNECTION DATA CITY TEL NO .TION DEPTH ATE MANHOLE REFERENCE 40 a s Oak REGISTRATION NO COUNTY LOWER NO GESCRIP N OF O K FEE TYPE OF CON E LENGTH FROM HOUSE SEWER CONNECTING TO Y PSL M L TO P IL } PUBLIC SEWER $5 00 PC NO d SEPTIC TANK SEEPAGE PIT OR O PITS AND/OR DRAINFIELD @ $10 00 CO IMP .108 NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ 53 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIVER EASfNeNT RECORD INSTR NO DATE `O WORK TO HOUSE 5EWER @ $300 y OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MA E $500 ALTER REPAIR OR ABAN ry E HWY OR ST WIDENING H SEWER OR DISPOSAL 5 E S300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES _ OWNER'S PERMIT s CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR 5 SIGNATURE SIGNED THIS_ '7' DAY OF 116filt 19" OWNER OR NEW HOUSE SEWER OWNERS AGENT -E'Lrli �/,•� CONNECT ADDITIONAL ADDRESS O J TG BUILDING OR WORK SEPTIC TANK SEEP PIT(5) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICE NSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER 1 SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD (\cK M o CASH SUPERVISING MECHANICAL ENGINEER [_iljl,o 5 6 8 6%—D NOV 6 11 D 2 5.0 0 " 0�d / C E808 10-63 76A6420 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 WILLIAM A JENSEN Sup t of Building / LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS ST LEGAL DESCRIPTION LOT NO OWNER -l—i.—^/lAI MAIL BLOCK TRACT / t ADDRESSNO BLDG ` SIZE OF LOT NOWOON LOTS CITY TEL NO/4Tk"74,P,3 USE OF BUILDINGS DISTRICT NO GROUP BK PG MAP P ESSED BY CONTRACTOR Q ' ✓' y i (sir /� /) � � ADDRESS ' �� CONNECTION DATA CITY ' TEL NO ATION E_PjF'H REGISTRATIONNO j 'ATE MANHOLE REFERENCE Y COUNTY LOWER NO GESCRIP O RK FEE TYPE OF CONNE N LENGTH FROM �Jy HOUSE SEWER CONNECTING TO Y R P L M L TO P L PUBLIC SEWER @ SS 00 l SEPTIC TANK SEEPAGE PIT OR P C NO O PITS AND/OR DRAINFIELD @ 51000 CO IMP NO JOB NO U HOUSE SEWER CONNECTING TO TRUt K PERMIT NO l ROAD PERMIT NO �/�S� PRIVATE DISPOSAL SYSTEM (ED S3 00 1, HJR/ 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE FV WORK TO HOUSE SEWER @ S300 V OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE @ 5500 a ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING NzSEWER OR DISPOSAL SYSTEM @ S300 STATE ENCROACHMENT Pc RMIT NO `INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATIONTOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEW R / !�� APPROVALS DATE INSPECTOR S SIGNnTU SIGNED THIS. _DAY OF y 19� . �� / OWNER OR NEW HOUSE SEWER 1 OWNERS AGENT f n CONNECT ADDITIONAL ADDRESS !/�/ . �� BUILDING OR WORK SEPTIC TANK SEEP PIT(S) L�R:ES EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BING AND SEWERS CESSPOOL ❑ DRYWELL ❑ EREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR NSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM FORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND DE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER ATURE ❑ PERMITTEE BACKFILL SEPTIC TANKS r SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH �l;�0 5 6 8 5 OV 6 1 0 D 7.00- `'