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HomeMy Public PortalAbout5928 CLOVERLY AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES Q n/ //�� �1i WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS ,�7 Z� /' / l.�/�/V'/T /V / /c FOR APPLICANT TO FILL IN LOCALITY 7" �/���/may ,(0!BUILDING �/~/`y AREST ADDRESS I N SS ST _ LAS / U{lr�j 4- LOCALITY i DISTRICT NO SERIALNO ,)PERMIT NO C NEAREST 15— - - A ;2276 t 37 3 1 CROSS S40 ECEIVED BY Ready for Inspection DATE ISSUED OWNER r ----------- i MAIL ADDRESS Q ( USE ZONE OCCUPANCY MAP q BK PG/' CITY TEL NO tp� n�Jl^ CONTRACTOR CO.IMP NO 131-8 ,7 c— ADDRESS �(,! J CITYL NO TRUNK-PERMIT PTO REGISTRATION 10 -17 �/ STATTY- ROAD.PERMIT-NO LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO `y PERMIT'N�O BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT sb V NO OF OW ON LOTS CHARGESJ_ USE BUILDINGS r�1 © CONJFE9Ti0N CHy1RG£FEE�� NGS NO DESCRIPTION OF WORK FEE­ HOUSE HOUSE SEWER CONNECTING TO REIMBURSEME T FEE PUBLICSEWER Q $ 350 RECEIPT NO / DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR EXCIfPTQ,0N RECORDED WORK TO HOUSE SEWER 100 / G�� ALTER OR REPAIR EXISTING / NO I (BY SEWER OR DISPOSAL SYSTEM 1 00 DISCONNECT AND AND/OR DISPOSAL SYSTEMN SEWER 1 00 CONNECTION DATA SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD 200 STATION -2 + JZ zf: DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 3��.�+tfY �� MANHOLE REFERENCEUPP -L-OWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT - $ I 1 00 Y CURB PL ML TOP L AUTHORIZATION TOTAL FEE I Z co NAED CONTRACTOIR TO CONNECT THDATETE ED ABOVE DE CRIBEDWITH-THEI EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS _ DAY OF _ 1q _ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ BUILDING OR WORK SEPTICTANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL E] � > 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AHD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY, ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOV SCRIBE REST NTIAL PERT BACKFILLSEPTIC TANKS � SIGNATURE SEEP PIT(S)D CESSPOOLS OF PERMITTEE _ y 76A642D 663 1/53