HomeMy Public PortalAbout5946 1/2 CLOVERLY AVE_Sewer__ S&E46 81155 APPLICATION! FOR PERMIT�'�'z/g5 .4.
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING ,✓/; /_��
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN Caoss ST
LEGAL /' I� !_ OWNER
DESCRIPTION LOT NO
MAIL / ♦ "
BLOCK TRAC ADDRESS A4 �C
r
NO OF BLCITY TEL NO
SIZE OF LOT NOW ON LOTT
USE OF
BUILDINGS DISTRICT NO GROUP I MAP
BK PG
CONTRACTOR
ADDRESS ' ` CONNECTION' DATA
CITY 4, TEL NO
tJ STATION DEPTH {O
MANHOLE REFERENCE
❑ STATE ♦ OWER
REGISTRATION NO117 Q ❑ COUNTY
No DESCRIPTION OF WORK FEE
(�
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y CURB P L M L TO j P L J
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $300
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
EXTN CESSPOOL DRYWELL,MANHOLE Q $2 00 CO IMP NO , ,'3 10B NO
HOUSE SEWER CONNECTING TOR I
6
PRIVATE DISPOSAL SYSTEM Q $1 00 a TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE ARNLCIYAL
RGES
CONNECTION CHE FEE
OWNER'SPEST S 1 00
REI MBURS MENT FEE
AUTHORIZATION I TOTAL FEE
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS - DATE I INSPECTOR SSIGNA E
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 26
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD -
I HEREBY CKNOWLEDGE 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
1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA P PERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF PERMITTEE Z
JOHN A LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
vM CK m 0 CASH
6S MAY 23 4 A 5.50