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Home My Public Portal About5418 CLOVERLY AVE_Sewer__ V �P 3 ;4 7C E8 6A64 APPLICATION FOR PERMIT 6A642D "COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A LAMHIE County Engineer WILLIAM A JENSEN Sup t of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO OF BLD GS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROU MAP PROCESSED BY BUILDINGS s� BK PG 4DA CONTRACTOR9ADDRESS � b CONNECTIO 3 BUD STATION DEPTH CITY TEL NO STATE MANHOLE REFERENCE UPPER REGISTRATION NO — / ❑ COUNTY 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 @ $5 00 PC NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO a PITS AND/OR DRAINFIELD @ S1000 O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO U PRIVATE DISPOSAL SYSTEM $300 CONNECT ADDITIONAL BLDG QR `,O AFFIDAVIT WAIVER 5 ER7 R ORD INSTR NO DATE O . RTO HOUSE SEWER $300 V OVERFLOW SEEPAGE PIT DRAINFIELD ' ,� H EXTN CESSPOOL DRYWELL MANHOLE @ 5500 / U LU ALTER REPAIR OR ABANDON HOUSE HWY OR 6T WIDENING "�tj E-42- ,./ "1 d a- SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT N PERMIT NO INDUSTRIAL ` WASTE APPROVAL OWNER'S PERMIT $ 2 00 CHARGES AUTHORIZATION TOTAL FEE 5OO CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INS CTORB IGN TURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LRESIDE AND SEWERS CESSPOOL ❑ DRYWELL ❑ t CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR S REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM OR THAT.I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND THE OV ESCRIBED RESI NTIAL PROPERTY ABANDON HOUSE SEWER BACKFILL SEPTIC TANKSTTEESEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD cK M o cnsH SUPERVISING MECHANICAL ENGINEER L i�,c 7 1 0 JUL 31 1 5.0 0— rt ' 4� :EBOB362 APPLICATION FOR PERMIT 16A642D . u COUNTY OF LOS Ar4GELES 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 L flIPROCESSED NEAREST FOR APPLICANT TO FILL IN `ROSSBTLEGAL DESCRIPTION LOT NO OWNERC/.,MAIL ��BLOCK TRACT /�/-� ADDRESSSIZE OF LOT D C/NOWOON LOTS CITY rTEL NO USEOF DISTRICT NO GROUP MAP BUILDINGS BK PG CONTRALTO ADDRESS CONNECTION ATA CITY TEL NO STATION DEPTH STATE LIC MANHOLE REFERENCE f LICENSE NO CLASS , OWER NODESCRIPTION OF WORK FEE TYPE OF ION LENGTH FROM HCURBOUSE SEWER CONNECTING TO Y P L M L TO P L d PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR MP NO JOB J NO C NO O PITS AND/OR DRAINFIELD @ 51000 CO IV HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO 9w PRIVATE DISPOSAL SYSTEM @ S300 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIYEN EASEMENT RECORD IN TR NO DATE 0 WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD lJ.l EXTN CESSPOOL DRYWELL MANHOLE @ $500 a ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING H SEWER OR DISPOSAL SYSTEM @ $300 B� STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE \ CONNECTION CHARGE FEE ITHAVE AT THIS DATE A CONTRACT WIH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SE FJJ /�/� APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS �`� DA OF T. xz g: 1 OWNER OR NEW HOUSE SEWER OWNERS AGENT _ CONNECT ADDITIONAL t BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PITS) I HEREBY ACKNOWLEDGE THAT I HA READ 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 ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DIS P OSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE AB/Q E DE ft ED RESIDENTI L PROPERTY ABANDON HOUSE SEWER 2�i / �Olt� SIGNATURE /� BACKFILL SEPTIC TANKS ❑ OF PERMITTEE .G Q2 SEEP PIT IS) ❑ CESSPOOLS ❑ 6SUPEALIDATION JACK R ALLEN M O CASH RVISING MECHANICAL ENGINEER Ltii,U 5 0 0 5 JUN 1 0 1 0 D 5.0 0 CE8083 62 76.642D ' APPLICATION FOR PERMIT � COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONBUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUP T OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS 5T LEGAL DESCRIPTION LOT NO OWNER _ MAIL BLOCK TRACT t ADDRESS NO OF BLDGS SIZE OF LOT Ot NOW ON LOT CITY �,._l TEL NO USE OF DISTRICT NO GROUP MAP PROCESSED BY BUILDIBK NGS PG CONTRACTOR ADDRESS CONNECTION DATA STATION DEPTH CITY TEL NO I� STATE LIC MANHOLE REFERENCE UPPER LICENSE NO GLASS LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L d PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR JOB NO C NO O PITS AND/OR DRAINFIELD @ 51000 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ S3 00 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAlv[R ESS EM EXT RECORD INSTR NO WORK TO HOUSE SEWER @ $300 (,J OVERFLOW SEEPAGE PIT DRAINFIELD LLI EXTN CESSPOOL DRYWELL MANHOLE @ $500 d ALTER REPAIR OR ABANDON HOUSE HWY OR 5T WIDENING h SEWER OR DISPOSAL SYSTEM @ $300 3106 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE oa CONNECTION CHARGE FEE CHARGES IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC 5 APPROVALS DATE INSPECTOR 5 SIGNATURE SIGNED THIS DAY OF I OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL S YSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND / RESIDE IN THE ABO E DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER / SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PITIS) ❑ CESSPOOLS ❑ QVALIDATION JACK R ALLEN CK M o CASH SUPERVISING MECHANICAL ENGINEER X50881 JUN18 1 0 D 5.00- I