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Home My Public Portal About5512 CLOVERLY AVE_Sewer__ 2170 76A6A 64 642D APPLICATI N FOR ERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION f UILDING JOHN A LAMBIE COUNTY ENGINEER DDRESS �RV1 COLEMAN W JENKINS SUP T OF BUILDING OCALITY F R APPLICANT TO FILL IN EAREST (PRINT OR TYPE ONLY) RosS57 LEGAL .. DESCRIPTION LOT NO OWNER MAIL BLOCK TR T ADDRESS NO OF BLOGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF I BUILDINGS /' DISTRICT NO GROUP I CLASS -APP, CESSED BY BK �i CONTRACTOR 7_ ADDRESS �' � X CONNECTION DATA CITY TEL NO STATION DEPTH STATE f LIC MANHOLE REFERENCEUPPER f LICENSE N ! / OLAS LOWER NO DESCRIPTION OF WCMK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO 7. Y CU L L TOP L PUBLIC SEWER 0 y SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ 51000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PER NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM f3 00 O CONNECT ADDITIONAL 9!456 IY[R [A5[M[ OR 00 AFFIDAVIT wANT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $30" U OVERFLOW SEEPAGE PIT DRAINFIELD OC EXTN CESSPOOL DRYWELL MANHOLE 0 $500 HWV OR ST WIDENING O ALTER REPAIR OR ABANDON HOUSE F„ SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT W PERMIT NO CL INDUSTRIAL Z WASTE APPROVAL OWNERS PERMTf s CHARGES AUTHORIZATION CONNECTION CHARGE FEE TOTAL FEE ' 1HAVE 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 S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL /1, BUILDING OR WORK .'o ADDRESS SEPTIC TANK SEEP PITIS) I HEREBY ACKNOWLEDGE A I HAVE READ THIS AP LIGATION gND�OR DRAINFIELD AND STATE THAT THE ABOV 1 CORRECT AND AGREE O COMPLY WITH ALL COUNTY ORDIN N S AND STATE L S EGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THA I AM PROPERLY R GIST RED A OR ALTER REPAIR SEWER OR LICENSED AS REOUI LOS ANGLES COU TY STA E OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR T I LEGAL F D INT N TO DISCONNECT PLUG AND RESIDE IN T ABOV S I RE ID T A 0 RTY ABANDON HOUSE SEWER ` SIGNATURE BACKFILL SEPTIC TANKS ❑ (Ii OF PERM TEE SEEP PIT(S) El CESSPOOLS ❑ y/ VALIDATION JACK R ALLEN CK M 0 CASH SUPERVISING MECHANICAL ENGINEER TEMPLE CI'T'Y 76A6420 cBeoe 8APPLICATION FOR P E R M I Mapor \ COUNTY OF LOS ANGELES SEWER— AGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DNISION BUILDING JOHN A LAMBIE County Engineer ADDRESS CASSATT D GRDTM, Supt of Buildmq LOCALITY NEAREST » FOR APPLICANT TO F l IN ceoss sr LEGAL DESCRIPTION LOT NO - OWNER BLOCK TRACT MAIL ADDRESS 0 OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USOF BUE DINGS DISTRICT NO GROUP BK PG MAP PROC P BY" CONTRACTOR I' ADDRESS CONNECTION DATA CITY TEL NOT TION DEPTH STATE MANHOLE REFERENCE PPE REGISTRATION NO G , COUNTY = 0, NO I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO ✓ PUBLIC SEWER @ $3 0 0-0 YPE C N T N LENGTH FROM SEPTIC TANK SEEPAGE PIT OR L M L TO P L PITS AND/OR DRAINFIELD @ $100 _ OVERFLOW SEEPAGE PIT DRAINFIELD _ EXTN CESSPOOL DRYWELL @ 12 00 // �7 PRIVAEWER CONNECTING DISPOSAL SYSTEM TO TE $I @ 00 CO IMP NO � G Lp JOB NO - CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO WORK TO HOUSE SEWER $I 00 ALTER REPAIR R ABANDON SYSTEM HOUSE $I 00 STATE ENCROACHMENT SEWERPERMIT NO INDUSTRIAL ' WASTE PROV L OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE Z 1 40 REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE I INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ NEW HOUSE SEWEROWNER OR OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S)- AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [:1 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 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE DISCONNECT PLUG AND OF DISCONNECT HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDE PROP RTY BACKFILLSEPTIC TANKS ❑ SIGNATURE SEEP PITS) ❑ CESSPOOLS OF PERMITTE ®r VALIDATION ROBERT A WOOD CIL M o CASH SUPERVISING MECHANICAL ENGINEER LA 'o 6 7 3 0 NOV 8 1 0 0 7.0 O— CQ r+ TEMPLE CITY CfiaoJ„� _ APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _ ADDRESSw JOHN A EPIMBIE, County Engmeer C.ASSATT D GRIFFIN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FELL IN A CROSS ST LEGAL DESCRIPTION LOT NO OWNER BLOCK TACT MAIL ADDRESS BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP BK PG MAP PROCES BY CONTRALTO ✓✓✓ ADDRESS CONNECTION DATA CITY TEL N6 16_aQTION D DEPTH STATE MANHOLE REFERENCE UPP REGISTRATION NO COUNTY No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO �nNLENGTH FROM f PUBLIC SEWER @ 00 SEPTIC TANK SEEPAGE PIT OR ^n ^^''^rT M L TOP L PITS AND/OR DRAINFIELD @ 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ 2 00 HOUSE SEWER CONNECTING TO P C NO 0 PRIVATE DISPOSAL SYSTEM @ 1 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT N WORK TO HOUSE SEWER @ 1 00 ALTER R REPAIR R ABANDON HOUSE @ I OO STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE ROVAL A OWNER'S PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE NAMED CON- TRACTOR TO CIONNE T THE ABOVE DESCRIBED EXIISTDATE A CONTRACT WITH THE IING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS SAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 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 THE LEGAL OWNER OF THE ABOVE DESCRIBED RESID L PR ERTY SEEPFILL PIT(S) CESSPOOLS ❑LS ❑ SIGNATURE OF PERMITTE 6QajQg� Aj T Or VALIDATION ROBERT A WOOD, CR It 0 CASH SUPERVISING MECHANICAL ENGINEER LZ06731%r-O NOV 8 1 1 D 25.00^' 1