HomeMy Public PortalAbout5950 CLOVERLY AVE_Sewer__ DF,PAS,,TMLN.'' OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 4
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER BUILDING
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RECEIVED BY Ready for Inspection DATE ISSUED
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CITY 6_C�- TEL NO Z a TRUNK PERMIT NO
REGISTRATION NO /QQ 7—/f7 Z-OAtliifT7
ROAD PERMIT NO ----------�
LEGAL2OO STATE ENCROACHMENT
DESCRIPTION LOT NO t' PERMIT NO
BLOCK TRACT WADUSTRIAL
STE APPROVAL
NO OF BLDG
SIZE OF LOT 0 (/ �� 10 ON LOTS CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE �-
NO DESCRiptiON OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 350 RECEIPT NO DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 / DU NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAE
PITS AND/OR RAINFGE DIT OR 200 STATION 3 f-C i DEPTH /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200D /I MANHOLEREFERENCEEFERENCE -LOWER-
TYPE
LOWERTYPE OF CONNECTION ✓ LENGTH FROM
OWNERS PERMIT g l 1 00 Y CURB -- PL M L TO P L
AUTHORIZATION I TOTAL FEEf HAVE DATE CONTRACTED WITH THE
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NAED
CONTRACTOIR TO CONNECT THE ABOVE D SCRIBEDIEXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL 1
OWNERS AGENT _ _ BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BYq LOSI ANGELES COUNTY) DISCONNECT PLUG AND
AND STATE OF CALIFO,Rp 1`A OR)THAT/I/A'M THE LEGAL WNL ABANDON HOUSE SEWER
ER OF THE ABO ���III D BRIBE D� TIAV T ` v BACKFILL SEPTIC TANKS
��f 4 SEEP PIT(S)E] CESSPOOLS
SIGNATURE NA'°�'
OF PERMITTEE Q_ _
76A642D 663 1/53
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX. COUNTY ENGINEER I BUILDING 5y,�
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P13FCASSATT D GRIFFIN, SUPT 13F BUILDIN13 ADDRESS Cl
FOR APPLICANT/� /T�O FILL /ISN ` '/ LOCALITY 7-amp 4- 66,BUILDING �� / ! �f r
NEAREST
ADDRESS 17 /Y ` 19Y/-" ,17 CROSS ST 1Eaf/ (, "L&I �- a)")o CPra 4e� 4w
LOCALITY �� / h� /� 1/ 11 DISTRILCT NO A SERIAL NO ! PERMIT NO C
NEAREST �� r+ � �+ �j J� J W�� (�2� � J
CROSS ST ��++J \'��V�J KJ^ �y RECEIVED BY Ready for Inspection DATE ISSUED
OWNER �(/r /Y)/4�/%� 34—ox/ 1-1-9-63
MAIL
ADDRESS 65410 64 p /rR / / USE ZONE OCCUPANCY BK MAP PG
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CITY / 4./Z` e ?' TEL NO Y /1 Y i
CONTRACTOR ��� a �� �� CHARGES REIMBURSEMENT FEE
ADDRESS f�Q �� ��� REQUIRED
NOT REQUIRED
CITY C TEL NO JOB NO �j CONNECTION CHARGE FEE
REGISTRATION NO oe, STATE eaT — CO IMP NO
LEGAL RECEIPT NO I DATE _^I BY
DESCRIPTION LOT NO 3,o Q
BLOCK TRACT -� jE'- �y � WAIVER FOR RECORDING
SIZE OF LOT;n?A/5- NOW ON LOTS RECEIPT NO I DATE -_r I BY `
USE OF
BUILDINGS , &4 TRUNK PERMIT NO
NO DESCRIPTLON OF WORK FEE
HOUSE SEWER CONNECTING TO c7� ROAD PERMIT NO
PUBLIC SEWER Q $ 350 STATE ENCROACHMENT
HOUSE SEWER CONNECTING TO PERMIT NO
PRIVATE DISPOSAL SYSTEM 1 00
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 STATION 3 f- DEPTH
AND/OR DISPOSAL SYSTEM 100
SEPTIC TANK SEEPAGE
PTS AND/OR DRAINFIIELDIT OR 200 I MANHOLE REF RE C p
CESSPOOL—DRYWELL UPPER G� j SeQ't LOWER
SPECIAL CONDITIONS ONLY 200 I TYPE OF CO NECTIONLENGTH FROM
--
Y CURB - P L A M L TO-P L
OWNERS PERMIT = I 1 00 -
AUTHORIZATION I TOTAL FEE I L/ `y'm
NAED
CO TRACTOIR TO CONNECT THDATETE ED ABOVE D SCRIBEDWITH THEI EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS OF 19 NEW HOUSE SEWER
OWNER OR � CONNECT ADDITIONAL
OWNERS AGENT �J�J_ BUILDING OR WORK
ADDRESS S_`l-��/(d7 SEPTIC TANK SEEP PIT(S)
R
s c AND/ODRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 H E READ THIS APPLI- CESSPOOL 0 DRYWELL
CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY/THAT I AM PROP RLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY,LO ANGELES CON NT
AND STATE OF CALIFORNIA HAT IT E W ABANDON HOUSE SEWER
ER OF THE ABOV DESCRI E E E IA /P BACKFILL SEPTIC TANKS i
SIGNATURE SEEP PIT(S)� CESSPOOLS 5.22
6], y�
OF PERMITTEE42 _
76A642D 663 12/52