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HomeMy Public PortalAbout5822 CLOVERLY AVE_Sewer__ 4 6&&8869 11 ES APPLICATION FOR PERMIT 1 S&E DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles rLADDRESS ING JOHN A LAMBIE COUNTY ENGINEER CASSATTO GRIFFIN SUPTOFBUILDING ITY FOR APPLICANT TO FILL IN CROSS T 0<LEGALJ DESC IPTION LOT NO OWNERMAIL ✓�//'�/J �Gyf� BLOCK TRACT ADDRESS LJ�/yJ .� 'ANO OF BLDGS CITY ?� TEL N67 :9-2 SIZE OF LOT NOW ON LOT USE OF DISTRICT NO GROUP MAP BUILDINGS _ / (.'� �l�LJr �� PG CONTRACTOR d C / I �K 1_3 CONNECTION DATA ADDRESS STATION DEPTH CITY TEL NO .I_ MANHOLE REFERENCE/ TATE �P OWER REGISTRATION NO ❑ COUNTY , NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OFC TION LENGTH FROM Y URB PL M L TOPL PUBLIC SEWER @ $3 50 � SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE PIT DRAINFIELDP C NO EXTN CESSPOOL,DRYWELL,MAN HOLE @ $2 00 CO IMP NO 10B NO HOUSE SEWER CONNECTING TO ' PRIVATE DISPOSAL SYSTEM Q $100 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER © $100 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL - SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'SPERMIT $ 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE � APPROVALS DATE INSPECTOR SSIGNATURE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER ` SIGNED THIS DAY OF 1 CONNECT ADDITIONAL T , w OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK SEEP,PITS) ADDRESS AND/OR DRAINFIELD I HEREBY ACK O LEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ ! AND STATE THA HE 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 RESIDENTIATj�CJ BACKFILL SEPTIC TANKS❑`69 d SIGNATURE SEEP PIT(S) ❑ CESSPOOL. �, � OF PERMITTEE JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR CK N O CASH ` L,'CO 6 1 6 _- OGT ?9 1 0 A 5.0 0 J 78A6 APPLICATION FOR PERMIT 1 1 ;DIVISION OF BUILDING AND SAFETY SEWED-SEWAGE DISPOSAL Department of County Engineer 7-- County Of LOS Angeles BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY'; FOR APPLICANTTy TO FILL IN _CR sr c� LEGAL DESCRIPTION LOT NO / / OWNERMAIL BLOCK TRACT / ADDRESS NO OF BLDGS CITY TEL NO SIZE OF LOT d / NOW ON LOT' USE OF BUILDINGS DISTRICT NO GROUP MAP � BK PG CONTRACTOR � ADDRESSr CONNECTION DATA � Q 1 STATION O� O DEPTH J CITY TEL NO ��^�/ MANHOLE REFERENCE ' ,�/ UPPER REGISTRATION NO ` �� !� ❑ COUNTY TY E 41 /� ` WER NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM / Y CURB P L M L TO P L PUBLIC SEWER @ O SEPTIC TANK SEEPAGE PIT OR a PITS AN DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD / / P C NO CO IMP NO EXTN CESSPOOL,DRYWELL MANHOLE @ $2 00 JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMEN WORK TO HOUSE SEWER @ $1 00 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL /J EWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL �s4. jr eln CHARGES ' 2 CONNECTION CHARGE FEE 1--DI, I OWN 'SERPERMIT $ 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE I ECTOR SSIG 11TURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER .. j��-x�e NEW HOUSE SEWER /O SIGNED THIS DAY OF � 1� CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT _ SEPTIC TANK,SEEP, PITS) ADDRESS�� • / AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE REAd THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND 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 RESIDENTIAL PERTY BACKFILL SEPTIC TANKS❑ P P1T(S) ❑ CES OOLS - SIGNATURE OF PERMITTEE 2 JOHN A LAMBIE COUNTY ENGINEER ^VALIDATION ROBERT A WOOD CHIEF PL IN ECTOR GCI N O CASH LA0 6 1 6 7 1 OCT 2 9 1 0 A 5.0 0 M 7eAed24� APPLICATION FOR PERM! CE806,11-87 COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL. J DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 10HN A LAMBIE Count Ea4me®r ADDRESS C SA1T D GRIFFIN, Supt of Suildmg - e LOCALITY -�� - 1 -t FOR APPLICANT TO FILL IN NEAREST - - FLOCK ION LOT NO OWNER - TRACT MAIL ADDRESS .T / NO OF LDGS T✓D / NOW ON LOT CITY 3 TEL LNO- USE,OF BUILDINGS DISTRICT I G MAP BK PG CONTRACTOR � / d ADDRESS //, , ter CONNECTION DATA CITY EL NO STATION DEPTH Cr REGISTRATION NO ,' �Q�' COUNTY MANHOLE REFERENCE /L �'/ U 7 Y LOWE NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO91,44 PUBLIC SEWER Q SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3 00 Y CURB P L M L TOP L OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 - HOUSE SEWER CONNECTING TO P NO PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO, , o JOB NO CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYST @,$1 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL r , WASTE APPROVAL CHARGES OWNERS PERMT $ AaWpw CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE D D REIMBURSEMENT FEE I HAVE AT DATE A CONTRACT WITH-THETRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGAMED DWELLING APPROVALS DATE ECTOR S IGNATURE ^. TO THE PUBLIC SEWER SIGNED THIS Y� DA OF g'� NEW HOUSE SEWER - OWNER OR CONNECT ADDITIONAL-- -OWNERS AGE BUILDING OR WORK ADDRESS -- SEP_TICTANK SEEP PIT(S) - - AND/OR DRAINFIELD' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _,CESSPOOL ❑ DRYWELL❑ - -- - -^ WITH-ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS ALTER REPAIR SEWER OR I HEREBY CERTIFY THAT-I AM PROPERLY-REGISTERED-AND/OR -SEWAGE DISPOSAL SYSTEM- - CENSED AS REQUIRED BY LO - - - -- LIS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT M THE LEGAL_OW _R OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED'RESIDEN L OPERT BACKFILL SEPTIC TANKS❑ EP PIT(S) ❑ POOLS SIGNATURE _ _ - OF,PERMITTE " - O Or VALIDATION - ROBERT A WOO m o CASH_- -SUPERVISING MECHANICAL ENGINEER - w -- N 6 1 6-9 OCT-?9 1-1 Ajo a