HomeMy Public PortalAbout5508 CLOVERLY AVE_Sewer__ DEPARTMENT OF COUNTY E_140IN MR SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS .ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I ANG
DD LDEIS3 �, ✓�'
01
FOR APPLICANT TO FILL IN LOCALITY �,G
BUILDING !T U 17/ ,_���/ y CROSSST ��/ Gd//�
ANEAREST
DDRESS • r•,yO (;6.�
LOCALITY DISTRICT DISTRICT NO l SERIAL NO PERMIT NO cc
NEAREST �r ��®/J
CROSS ST `, RECEIV Ready for Inspection DATE SUE
OWNER if ,✓ /
MAIL "` USE ZON OCCUPANCY
ADDRESS,/,044A
BK
CI /si• TEL NO � Y1 I P3�
CONTRACTOR r �/ CO IMP NO
ADORES yy JOB NO
CITY TEL NO IJf TRUNK PERMIT NO
REGISTRATION NO COUNTY ROAD PERMIT NO
LEGAL '" V ' 1406' STATE ENCROACHMENT .. _— -----
DESCRIPTION L T _ PERMIT NO
BLOCK TRACT/Vg/U/ale6?f INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NOW ON LOT
NO OF BLDGS CHARGES
5
USE OF
BUILDINGS L"t' ke'l-1-11t166- CONNECTION CHARGE E
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 _ RECEIPT NO X DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION kCORDED
' WORK TO HOUSE SEWER 1 00 NO
t ALTER OR REPAIR EXISTING ( DAT I BY
' SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
Y SEPTIC TANK SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 200 STATION D �5-g. QDEPTH
' CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 ,k / ANH�O¢EREFERENCE OWER
Y YPE OF CONNECTION e LENGTH TTOHPFROM��
' OWNERS PERMIT ; I I 00
AUTHORIZATION TOTAL FEEI HAVE THIS DATE CONTRAC12-0 CCQ!/�-.�'
i NAED
CONTRACTOR TO CONNECT THTE ED ABOVE D SCRIBEDWITH THEIEXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
y DWELLING TO THE PUBLIC SEWER �
SIGNED THIS 7 DAY O _'!�'a!- -- _19 NEW HOUSE SEWER Q p G s--//)
-�
OWNER OR 6 _ CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ - - - - BUILDING OR WORK
��qq,, r SEPTIC TANK,SEEP PIT(S)
ADDRESS f.� J ! _ _ _ _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL El
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED L
AND/OR LI CENSE ND
SE REQUIRED BY LOS ANGELES COCONTY DISCONNECT PLUG AND
AND STATE OF LIF NIA OR THAT 1 AM THE LEGAL UWN-
ABANDON HO
PLUG
ER OF THE A VE SCRIBED RESIDEN IAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE C!Ey�y�9j- SEEP PIT(S)[] CESSPOOLS
OF PERMITTEE -
76A642A 663 7/53