HomeMy Public PortalAbout5930 CLOVERLY AVE_Sewer__ DEPARTBEENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES O 2
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS BUILDING 5730
CASSATT D GRIFFIN, SUP T OF BUILDING l
FOR APPLICANT TO FILL IN
rLOCALITY
BUILDI fj'oCNEAREST
ROSS STAD RES lJC
LOCALITY P�c. � DISTRICT NO SERIAL NO J T pPERMIT NO C
NEAREST A 7� 04
CROSS ST A {l /0
RECEIVED BY Ready for Inspection DATEISSUED
OWNER
MAIL �A _mow a
ADDRESS (�vYr�6es+ USE ZONE OCCUPANCY I MAP
BK PG
CITY TEL NO
CONTRACTOR K 9 1 CHARGES REIMBURSEMENT FEE
ADDRESS&&/ �,�Q, ��{�..�� REQUIRED
N - EQUIRED
CITY TEL NO � CONNECTION E,
STATE E �J�J
REGISTRATION lio CO IMP NO
LEGAL �Q/ RECEIPT NO DATE BY
DESCRIPTION LOT NO /(Q
BLOCK TRACT �y 5CD WAI ER FOR RECORDING
SIZE OF LOT 5 NO OF BLDGS
D x 17 �. RECEIPT NO JAI DATE BY _
NOW ON LOT
USE OF
BUILDINGS
NO DESCRIPTION OF WORK FEE TRUNK PERMIT NO \ ..........
HOUSE SEWER CONNECTING TO ROAD PERMIT NO
PUBLICSEWER (9'$ "350
HOUSE SEWER CONNECTING TO STATE ENZRVrAC�HMENT
PRIVATE DISPOSAL SYSTEM 1 00 PERMIT-NO
+ CONNECT ADDITIONAL BLDG OR i INDUSTRIAL \
WORK TO HOUSE SEWER 1 00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER 11__
AND/OR DISPOSAL SYSTEM 1 00 STATION -2 T" I 2.-157' DEPTH
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 MANHOLE REFERENCE
CESSPOOL—DRYWELL I I UPPER j$: -SLY of _LGWER
SPECIAL CONDITIONS ONLY 200
TYPE OF CONNECTION il/ LENGTH FROM
Y CURB P L R/ICy M L TO P L
, _ r
OWNERS PERMIT 1 00
AUTHORIZATION TOTAL FEE 1 4
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
0.
SIGNED THIS DAY OF 19' NEW HOUSE SEWER ]/(/"- A/I
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT ie �+ �cs�O� Cf� BUILDING OR WORK
ADDRESS J d J'v SEPTIC TANK SEEP PIT(S)
p AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0_DRYWELL ��77 t` ✓' /��
H CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE fff
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS ISEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
M AND/OR LICENSED AS REQUIRED BY LOS ANGELESCOUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF THE ABOV PESCRIBED RESIDENTIAL PRO ERTY BACKFILL SEPTIC TANKS
SEEP PIT(S)❑ CESSPOOLS E]
SIGNATURE
OF PERMITTEE wte�AEd J
76A642D b63 12/52