HomeMy Public PortalAbout5420 CLOVERLY AVE_Sewer__ 7QAB42D
CE908 11-97 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE_DISPOSAL .+1
DEPARTMENT OF COUNTY`ENGINEER
BUILDING AND SAFETY DIVISION BUILDING _ G
y JOHN A LAMBIE, County Engineer ADDRES •�/� -
CASSATTD GRIFFIN Sup t of Suildmg
LOCALITY -
FOR APPLIC T TO FILL IN 'NEAREST
CROSS ST _ T
w
LEGAL
DESCRIPTIO OWNERMAIL
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BLOCK TRACT ADDRESS
NO OFBLDGS
[SIZE OF LOT NOW ON LOT ./rte CITY TEL NO
USE OF �g��p
BUILDINGS DISTRICT NO G MAP
( I �KPG
CONTRACTOR y
ADDRES CONNECTION DATA ,
CITY T 3�-�-9� STATION DEPTH
REGISTRATION NO ❑ COUNTY MANHOLE REFERENCE UPPER
LOWER
F
ESCRIPTION F WORK FEE
SEWER CONNECTING TO
C SEWER $3 50
C TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
ND/OR DRAINFIELD @ $3 00 Y CUR P L M L TO P L
LOW SEEPAGE PIT DRAINFIELD
CESSPOOL DRYWELL MANHOLE @ $2 00E SEWER CONNECTING TO C NTE DISPOSAL SYSTEM @ $1 00ECT ADDITIONAL BLDG ORTO HOUSE SEWER @ $1 00 - V TRUNK PERMIT NO ROAD PERMIT NO
REPAIR OR ABANDON HOUSER OR DISPOSAL SYSTEM @ $1 00 STATE ENCRO CH �N ' G�
PERMIT NO O'-
�~ INDUSTRIAL
_ WASTE APPROV L
CHARG S
OWNER'S PERMIT $ 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
T ACTOR_TO CIONNECT THE ABOVE DESCRIBED EXISTDATE A CONTRACT-WITH THE IJNGAMED DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE_PUBLIC_SEWER
SIGNED THIS — DAY E 19 NEW HOUSE SEWER
OWNER OR - - ----- •-- LC
ECT-ADDITIONAL---1 -^ -
OWNERS AGENT ING OR WORK PIT(S)-
ADDRESS IC TANK SEEP PIT(S)-OR DRAINFIELD`IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOAND STATE THAT THE ABOVE_IS CORRECT AND_AGREE TO COMPLPOOL❑ DRYWELL-❑WITH ALL COUNTY ORDINANCESAND STATE LAWS REGULATINR REPAIR SEWERORPLUMBING AND SEWERS 1^HEREBY CER T-I AM"-PR RLY ` GISTERED' AND/OGE DISPOSAL SYSTEM------•LICENSED AS OU RED LOS AN L S C NTY AND STATE ONNECT PLUG AND
CALIFORNIA 0 T T E EG R OF THE_.ABOVDON HOUSE SEWERDESCRIBED R ID PR RTY FILL SEPTIC TANKSSIGNATUREPIT(S) ❑CESSPOOLS ❑ ^_
OF PERMITTET
ROBERT`A'WOOD...__,_,_-�......_.—
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