HomeMy Public PortalAbout4949 CLOVERLY AVE_Sewer__ I -
aD
CE808APPLICATION FOR PERMIT
saoe a sa COUNTY OF LOS ANGELES
r SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A LAMBIE, County Fngmeer
CASSATT D GRIFFIN, 3up't of Buzl&ng LOCALITY
NEAREST
FOR APPLICANT TO FELL IN CROSS ST rev e4l
FSIZE
AL
TION LOT NO OWNER L� C
MAIL
TRACT 3�7 /ADDRESS O
NO OF BLDGS r
LOT NOW ON LOTCITY TEL NO
' Agltz
USE OF
BUILDINGS TSTATE
ROUP P P� ROCESSED BY V
CONTRACTOR C _ P
01
ADDRESS ` d, ? CONNECTION DATA -
CITY TEL NO DEPTH
8FERENCE UPPERREGISTRATION NO NO DESCRIPTION OF WORK FEErHOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $S 00 TION LENGTH FROM
PITS AND%OR DSRAENFGELDIT OR $S 00UR - P L M L TOP L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TOC
NO
PRIVATE DISPOSAL SYSTEM 0 $1 00 CO IMP NO' JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTORS SIGN�ITURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED-EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS—SAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
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 I
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 PROPE BACKFILL SEPTIC TANKS❑ (/�
SIGNATURE SEEP PIT S ❑ CESSPOOLS JJ
OF PERMITTE /
®>' AL 11 0. I1j ROBERT A WOOD
y
eK. p, mag SUPERVISING MECHANICAL,fiNOINfifiR
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