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Home My Public Portal About4945 CLOVERLY AVE_Sewer__ 642DD 76A APPLICATION FOR PERMIT 76A 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �` I JOHN A LAMBIE COUNTY ENGINEER ADDRESS j L COLEMAN W JENKINS SUP T OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS Sr /14 (PRINT OR TYPE ONLY) LEGAL DESCRIPTION LOT NO / OWNER �T MAIL BLOCK TRACT ADDRESS NO OF BLDGS dl ^ SIZE OF LOT o_J NOW ON LOT CITY TEL USE OF DISTRICTNO GROUP CLASS MAP P CESSED BY BUILDINGS BK pS CONTRACTOR v � /b" ADDRESS -'3 0 �yQ� �,rk,}�(�(,�lry CONNECTION DATA CITY (,L C /-LCJ TEL NO /7 7 STATION O DEPTH LICENSE NO.4Q g J CLASS MANHOLE REFERENCE 7 3 UPPER ER NO DESCRIPTION F WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO . O Y CURB Q _ML TOP L PUBLIC SEWER @ 55 00 SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINFIELD @ f1000 CO IMP NO / / JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d PRIVATE DISPOSAL SYSTEM @ $300 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT MAI; [AS[M[Mt RECORD INSTR NO DATE WORK TO HOUSE SEWER @ 5300 1J 1 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ 55 00 HWY OR ST WIDENING O ALTER REPAIR OR ABANDON HOUSE H SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT W PERMIT NO a INDUSTRIAL h WASTE APPROVAL Z OWNERS PERmrr $ 2 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE D f7 ' IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO COV NECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANKSEEP PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS 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 DESCR EO RESIDENT ROPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTBACKFILL SEPTIC TANKS 11EE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION JACK R ALLEN V, K M O CASH SUPERVISING MECHANICAL ENGINEER �'�9 1 4 86---' BAR 15 1 !'D D 7.0 O N CaS a°azo °° 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 COLEMAN W JENKINS SUP T OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS BT GAL DESCRIPTION LOT NO OWNER 73 MAIL BLOCK TRACT ADDRESS NO OF BLDG& SIZE OF LOT NOW ON LOT CITY NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY OK PG C� ]((]�JJ� Jam^ CONTRACTOR 10.3 ADDRESS CONNECTION DATA CITY TEL NO STATION DEPTH I STATE LIC MANHOLE REFERENCE PPER LICENSE NO CLASS LOWER NO I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FRO HOUSE SEWER CONNECTING TO Y CURB P L ML TOP L ' PUBLIC SEWER $5 00 SEPTIC TANK SEEPAGE PIT OR P G NO PITS AND/OR DRAINFIELD $1000 CO IMP NO JOB NO ' HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD P MIT NO PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wA1V[[ [A5[Y[MT COR INSTR NO DATE V WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD O EXTN CESSPOOL DRYWELL MANHOLE @ f5 00 HWY OR ST WIDENING ~ TTt"9RAdA NDON HO SE V SEWER OR T3 00 STATE ENCROACHMENT PERMIT NO (n INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT s z Co CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO-CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLICS/E��v APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS 7-T-DAY OF 197-a f OWNER OR NEW HOUSE SEWER OWNERS AGENT .� CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANKSEEP PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE AD THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ r I� HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM I CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISC UG ,/ RESIDE IN THE MCRIBED RESIDENTIAL PROP RTY OHOUSE S J /SIGNATURE /^ ,/Iy //�j OF PERMTTTEE ` ' Gtr BACKFILL SEPTIC TANKS ❑ SEEP PIT(SI ❑ CESSPOOLS�!] ZS VALIDATION JA K R ALLEN CK` M O CASH SUPERVISING MECHANICAL ENGINEER ► A�'r 7 .5 9 OR NOV 12 1 -O D 5.0 0 Q D S&E 663 11 55 APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING �"� JOHN A LAMBIE COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY NST FOR APPLICANT TO FILL IN CCROSS S LEGAL1 3 OWNER DESCRIPTION LOT NO BLOCK TRACT / / fi ADDS �jNO OF BLDGS CITY TEL NO SIZE OF LOT U `'NOW ON LOT USE OF DISTRICT NO I GROUP I MAP BUILDINGS BK PG CONTRACTOR 3 i ADDRESS CODATA NNE TION O STATION DEPTH CITY TEL NO Y MANHOLE REFERENCE UPPER ❑ STATE LOWER REGISTRATION 0 COUNTY No DESCRIPTION OF WORK FEEadaee A27— O� HOUSE SEWER CONNECTING TO TYPE OF ONNECTION LENGTH FROM PUBLIC SEWER @ $3 50 Y URB P M L TOP L SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD P C NO EXTN CESSPOOL DRYWELL,MANHOLE @ $2 00 CO IMP NO x JOB NO HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM @ $1 00 _TRUNK PERM+ NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENeOACHMENT WORK TO HOUSE SEWER @ $1 00 PERMIT^O ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 AUTHORIZATION TOTAL FEE _REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SE E NEW HOUSE SEWER SIGNED THIS DAY OF 19 j CONNECT ADDITIONAL OWNER OR BUILDING OR WORK SEPTICTANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 51111CATION CESSPOOL❑ DRYWELL❑ ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE 0 COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR ' PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES CO AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM THE LEG ER F THE ABOVE DESCRIBED RESIDENTI PROPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PIT(S) El CESSPOOLS El OF PERMITTE ' JOHN A LA E COUNTY ENGINEER VALIDATIOROBERT A WOOD CHIEF PLBG INSPECTOR CK d O � 5 - AC 1 2 2 4 1101 KT 7 4 200 t0