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Home My Public Portal About5015 CLOVERLY AVE_Sewer__ TEMPLE CITY -61 76A6423-61 APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION fA UILDING �+ JOHN A, LAMBIE County Engineer DDRESS 90 JWILLIAMA JENSENSupt of Building CALITY emble C1tFOR APPLICANT TO FBI INRoss Lower Azusa LEGAL DESCRIPTION LOT NO42 OWNER Gordon Dean BLOCK TRACT MAIL 5013 Cloverly Ave, 1 2 ADDRESSNO OF /'e SIZE OF LOT X O NOW ON LOTS 2 7�A • TEL NO —_ - - USE OF �` --` BUILDINGS Res . DOUP MAP PROCESS BY PG CONTRACTO KADDRESS q Rdo CONNECTION DATA CITYEl Monte TEL NO.GI ,2020 J DEPTH STATE MANHOLE REFERENCE y"' REGISTRATION NO COUNTY LOWER No I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y 5URBA A P L M L TO P L PITS AND/OR DRAINFIELD @ S300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 d HOUSE SEWER CONNECTING TO P C NO O PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO V WOCONNECRK TOTHOUSEISEWER LDG OR @ 31 00 TRUNK PERMIT NO ROAD PERMIT NO ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT O SEWER On DISPOSAL ISPOSA SYSTEM @ $1 00 PERMIT NO 1 Saddle 25 OO WASTE APPROVAL H CHARGES Z OWNEIrs PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE 25 00 REIMBURSEMENT FEE DATE A CONTRACT WITH THE HEREIN NAMED CN- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OR 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT NEW BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PITS) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT t 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THELEGAL 0 ER F THE ABOVE DESCRIBED RESIDENTIAL ROP RTY BACKFILL SEPTIC TANKS ❑ SIGNATURE S PITS CESSPOOLS OF PERMITTE VALIDATION RUBERT A WOOD c M O CASH SUPERVISING MECHANICAL ENGINEER LknZ9080 AUG 1311 0 25.00- V TEMPLE CITY -81 7BA642D APPLICATION FOR PERMIT 8A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER C BUILDING AND SAFETY DIVISION ADDRESS D .7 Cloverl Ave. JOHN A, LAMBIE County Engineer WILLIAM A JENSEN Sup t of Building LOCALITY Tampl_p City FOR APPLICANT TO FU.L INCROSS s Lower Azuga LEGAL OWNER Dean DESCRIPTION LOT NO MAIL BLOCK TRACT 13329 ADDRESS5013 CloverlyAve. NO OF BLDGS SIZE OF LO NOW ON LOT CITY TEL NO BUEOF DINGS 2 Res: - _ DISTRICT NO G P MAP PROCES ED BY _ BK PG CONTRACTOR , rp Service ✓ ,I ADDRESS Rd. CONNECTION DATA CITY El Monte TEL NO GI 4-2020A ON 2 ��`- DEPTH STATE MANHOLE REFERENC REGISTRATION NO COUNTY LOWER NO DESCRIPTION 0 FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $300 5 00 TYPE OF CONNECTION LENGTH FROM ` SEPTIC TANK SEEPAGE PIT OR T CURB P L M L TO P L V-J PITS AND/OR DRAINFIELD @ $S 00 OVERFLOW SEEPAGE PIT DRAINFIELD >_ EXTN CESSPOOL DRYWELL @ S2 00 d HOUSE SEWER CONNECTING TO P C NO O PRIVATE DISPOSAL SYSTEM @ $t 00 CO IMP NO 1 JOB NO U CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMITNO WORK TO HOUSE SEWER @ S1 00 OSRORAROASNDN OUSE C. $100 STATE ENCROACHMENTEWE PERMIT NO IV INDUSTRIAL a WASTE APPROVAL N CHARGES ? OWNERS PERb= 51 2100 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER _ATEt INSPECTOR 2, SIGN l T Rei SIGNED THIS DAY OF 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OGS' OWNERS AGENT 7TBUILDING OR WORK ADDRESS D !IE SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL El WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTE14 I HEREBY CERTIFY THAT I AM PROPERXLGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELESTYANDSTATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL R OF THE ABOVE BACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDENTIAL/PROPERTY SIGNATURE y SEEP PIT S ❑ CESSPOOLS 01 OF PERM ITTE Y` CVN 0 ROBERT�. WOOD CK M o CASH SUPERVISING MECHANICAL ENGINEER 2 9 0 7 Avs 13 1 0 D 7.00-