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Home My Public Portal About5327 CLOVERLY AVE_Sewer__ D S&E 663 11 SS APPLICATION FOR PERMIT - S 8 E 8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Depoitment of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY 1 , FOR APPLICANT TO FILL IN CROSS s LEGAL OWNER DESCRIPTION LOT NO G A�tl'1� i v MAIL A� BLOCK TRACT ` ADDRESS NO OF BLDGS CITY TEL NO ` SIZE OF LOT NOW ON LOT USE OF DISTRICT NO GROUP I MAP ' BUILDINGS BK PG CONTRACTOR -ink ?L ADDRESS `"t CONNECTION DATA cDL CITY STATION I DEPTH G , .jZ fASTEL NO 4re- MANHOLE REFERENCEPPER 61 f ATE 7 L REGISTRATION NO ❑ COUNTY NO DESCRIPTION OF WORK FEE Q HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM I[ PUBLIC SEWER @ $3 50 (, Y CURB M L TOP L SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD P C NO i EXTN CESSPOOL DRYWELL,MANHOLE Q $2 00 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER Q $1 00 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q $100 WASTE APPROVAL CHARGES i CONNECTION CHARGE FEE OWNER'S PERMIT S t 00n` AUTHORIZATION TOTAL FEE _ REIMBURSEMENT FEE U G`r/L LS I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE HAVE TO CONNECT THE ABOVE DESEXISTING DWELLING � TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS �{�. TDAYY/�OF I9 CONNECT ADDITIONAL OOWNER OR WNERS AGENT 1106f / )7 A IT�771BUILDING OR WORK - f T T T SEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[IAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I 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 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTAL PROP RTY BACKFILL SEPTIC TANKS❑ �� Ay2ZVQ-_1e �f� SIGNATURE SEEP PITS) ❑ CESSPOOLS j/ OF PERMITTEE JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR CK N 0 CRSH p2 0 8 51s: SEPj 0- 4 4-.50 0 >l ,°-63 76A642D APPLICATION FOR PER IT 76A64IJ COUNTY OF LOS ANGELES SEWER-SEWAGE n DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS WILLIAM A JENSEN Supt of Building LOCALITY V t V NEAREST FOR APPLICANT TO FILL IN [CROSS ST a C✓L v LEGAL DESCRIPTION LOT NO G OWNER MAIL ` BLOCK TRACT ADDRESS L yy NO OF B GS SIZE OF LOT V / L NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP PROCESS BY BUILDINGS (i i^� f O „/ BK fPG CONTRACTOR 7-L, � ((J-/�J' / ADDRESSO C ECTION DATA CITY TEL NO .(/�,� `4J ~J STATION DEPTH TATE MANHOLE REFERENCE UPPER REGISTRATION NO COUNTY LOWER NO DESCRIP ION OF WO K FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L Al La P L } PUBLIC SEWER @ 55 00P C q SEPTIC TANK SEEPAGE PIT OR CO N Cj2 O PITS AND/OR DRAINFIELD @ 31000 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 gm CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ S300 !t/(�1 V OVERFLOW SEEPAGE PIT DRAINFIELD U EXTN CESSPOOL DRYWELL MANHOLE@ $500 pL ALTREPAIR OR ABANDON HOUSE HWY OR ST WIDENING h SEWER OR DISPOSAL SYSTEM @ E3 00 STATE ENCROACHMENT z PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR 5 SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) R I� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD 1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LE RL OWN F AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOV7E ESCRIBE R E IA PROPERTY ABANDON HOUSE SEWER SIGNATURE J _ BACKFILL SEPTIC TANKS ❑ OFPERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ LIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER iLACO4 8 9 9;3 JAN 27 1' 0 0 5.00 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0210160007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID SEWER / SEPTIC Y BUILDING ON FILE EXIST OCC GRP 5327 CLOVERLY AV BLDGS NOW ON LOT TEMP CA 917803106 ASSESSOROR ATI NUMBER CONNECTION TYPE NEAREST CROSS STREET OLIVE 8590-004-010 ORIGINATION THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY LENGTH ML TO PL, STATION DEPTH TENANT MANHOLE REFERENCE UPPER/LOWER ISSUED ON PROCESSED 10/16/02 JK 04/14/03 COUNTY IMPROVEMENT NUMBER OWNER TEL NO PLAN CHECK NUMBER FIN L E FINAL BY CODE KUBA DOWNEY, ELVINA (626) 286-4618- JOB NUMBER 5327 CLOVERLY AV TRUNK PERMIT NUMBER o� TEMP 917803106 ROAD PERMIT NUMBER D P ON AFFADAVIT- NO REPA R COLLAPSED SEWER PIPES WAIVER NO APPLICANT TEL NO SAME,AS OWNER - EASEMENT NO RECORD INSTRUMENT NBR_ RECORD DATE SPECIAL CONDITIONS HIGHWAY/STREET%WIDENING STATE ENCROACHMEN�PERMITvNUMBE\\ CONTRACTOR TEL NO // p SaP\D APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC NO FEE D77 ESCRIPTION��✓� QUANTITY �UOM\\�\ AMOUNT NSEWER � 01 PERMIT ISSUANCE FEE \ 27 75 CONNECT ADDITI A 15 ALT/REP HOUSE`SEWER —- 00 EAC 30 45 BUILDING OR WORK ARCHITECT OR ENGINEERTEL I/ �`+� TOTAL FEES \ 58 20�{ r �� `\ SEPTIC A G LIC NO E PIT AND/OR DRAIN FIELD DRYWELI SEWER MAP BOOK PAGE �n ALTER, REPAIR, SEWER OR SEWAGE DISPOSAL SYSTEM DISCONNECT -—% �j ABANDON HOUSE SEWER BACKFILL SE S _ SEEP PIT CESSPOOL GRAYWATER SYSTEM 8cE`� / REPORT ID DPR266 ROUTE TO BS0508 I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0210230004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID SEWERSEPTIC Y BUILDING ON FILE EXIST OCC GRP 5327 CLOVERLY AV BLDGS NOW ON LOT TEMP CA 917803106 ASSESSOR INFORMATION NUMBER CONNECTION TYPE NEAREST CROSS STREET OLIVE 8590-004-010 ORIGINATION THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY LENGTH ML TO PL STATION' DEPTH MANHOLE REFERENCE UPPER/LOWER ISSUED ON PROCESSED 10/23/02 JK 04/21/03 COUNTY IMPROVEMENT NUMBER 1 11 OWNER TEL NO PLAN CHECK NUMBER 51 AL AT FINAL BY CODE KUBA DOWNEY, ELVINA (626) 286-4618- JOB NUMBER 5327 CLOVERLY AV TRUNK PERMIT NUMBER (/ TEMP 917803106 ROAD PERMIT NUMBER DEC 0 AFFADAVIT NO RE OUT 20l SECTION OF SEWER PIPE WAIVER NO wmylrcm TEL NO EASEMENT NO R J COLLINS PLUMBING CO (626) 305-0075- 911 S PRIMROSE #F RECORD INSTRUMENT NBR RECORD DATE SPECIAL CONDITION MONROVIA 91016 HIGHWAY/STREET�WIDENING-=--_--,�_ STATE ENCROACHMENT--PERMIT-NUMBER= CONTRACTOR TEL NO --:,FEES.PAID APPROVALS DATE INSPECTOR SIGNATURE R J COLLINS PLUMBING CO INC (626) 305-0075- �y P 0 BOX 832 LIC NO FEE/DESCRIPTION QUANTITY NEAC OAMOUNT NEW HOUSE 911 S PRIMROSE AVE STE F 583305 C36 �// �j'' MONROVIA CA 91017 01 PERMIT ISSUANCE FEET /� 27 75 CONNECT ADDITI NAL 15 ALT/REP HOUSE S`EfWER }�1 00 30 45 BUILDING OR WORK ARCH TECT L /l �� TOTAL FEES58 20 �4SEPTIC TANK, SEEPAGE LIC NOf AND/OR DRAIN FIELD' �1111 l 1 tip DRYWELL _ r-- SEWER BOOK PAGE �� /�� ALTER, REPAIR, SEW OR U � � �j ( L SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND - —— ABANDON HOUSE SEWER BACKFILL SEPTIC SEEP PIT _ CESSPOOL _ 6E� I L 1 GRAYWATER SYSTEM nn- REPORT ID DPR266 ROUTE TO BS0508