HomeMy Public PortalAbout6058 CLOVERLY AVE_Sewer__ I
DEPARTMENT OF COUNTY ENGINEER _ SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES '
WILLIAM J. FOX, COUNTY ENOINEEH N I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN
/G LOCALITY /r�`,�'•�y��
BUILDING //' (-¢ �/� /n/�1/�•�( / 'T/f//e_5 CROSS ST.
NEAREST
ADDRESS E7VJ O ,y L/ /T
LOCALITY �w�D< LO t DISTRICT NO SERIAL NO. PERMIT NO. c
NEAREST
ROSST. GLIA/ rJ J 23 /?3^/5 2�2-2-J
RECEIVED Y Ready for Inspection �DDAAT ISSUED(
OWNER SQ �r EiC/fIJ�I
ADDRESS �(J /��(�O(�Gil�/GJ//{7�yr�b —USE 20N OCCUPANCY BK NId1'P PG
CITY Piyyt lL� �C7L�y TEL.NO. b J 3 5•• ! `•s/ I V�� I ��
T
CONTRACTOR (.1 S �� _ P CO.IMP.NO. / 7 7 _/197
ADDRESS JOB.NO.
CITY TEL.NO. % TRUNK PERMIT NO.
STATE
REGISTRATION NO. 8 COUNTY 'ROAD PERMIT NO
LEGDESCRIPTION LOT NO r®le 3 IJ / STATE ENCROACHMENT
r PERMIT NO
BLOCK TRACT ��� / k INDUSTRIAL
i WASTE APPROVAL
SIZE OF LOT' J �X N4 NO-OF BLD
OW ON LOTS i CHARGX
USE OF p� CONNECTION CHARGE FEE
BUILDINGSy A-7 M, V— � �
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER @ $ 3.50 I RECEIPT NO. /I ND_ATE BY I
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL-SYSTEM 100 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR l
PITS AND/OR DRAINFIELD 2.00 STATION -7 DEPTH
CESSPOOL—DRYWELL MANHOLE RE ERENCE
SPECIAL CONDITIONS ONLY 200 -
— PPER COWER-
TYPE OF CONNECTION_ LENG H_FRO_M
Yom -- CURB PL' ML TOPL �s
OWNERS PERMIT SII
AUTHORIZATION TOTAL-FEE �GI;
1 HAVETHIS DATE CONTRACTED WITH THE HEREIN NAMED,
CONTRACTOR, TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS._2' _.'.RAY OF I--w ` NEW HOUSE SEWER
or CONNECT ADDITIONAL /
OWNER //
OR ��Gr Vti BUILDING OR WORK
OWNERS AGENT ----- _.._.....
—pp A/� r�� SEPTIC TANK,SEEP.PIT(S)
ADDRESS— __'. _U __/J�.._..______.. _..__.�... _..___.�..' AND/OR DRAINFIELD
i
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL I] DRYWELL I]
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 DISCONNECT PLUG AND
AND/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 ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE ,,�r SEEP PIT(S)� CESSPOOLS
OF PERMITTEE __________ _ Y �
76A642A 663 7/53
r DF,PARTIVMNT OF COUNTY EiNGUaMR SEWER-SEWAGE DISPOSAL
,-DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
•„' WILLIAM J. FOX. COUNTY ENQINEER _I BUILDING
ADDRESS
FOR APPLICANT TO /FILL'IN LOCALITYBUILDING
NEAREST
ADDRESS 42 �� !V f C��L 0 ✓�/y An CROSS ST
LOCALITY + -�G �f�� 1—` DISTRICT NO A` SERIAL NO PERMIT NO
NEAREST f J
i� 3 Cj 3 c
CROSS ST (_C,) DAT�{y-/ � (�!/ UG RE Y Poo
Randy for Inspection ISSUED
OWNER
MAIL / �j USE 20NE OCCUPANCY B PG
ADDRESS (� f� PC (% v (y
CITY ��ZC !�e �'! EL MO. S 3� •�/ � .� I G
CONTRACTOR /f, CO.IMP.NO. /277 51_1101
ADDRESS JOB.NO.
CITY TELAO. TRUNK PERMIT NO.
STATE
REGISTRATION NO / COUNTY ROAD PERMIT N0. 2—
LEGAL �(��D O STATE ENCROACHMENT
DESCRIPTION LOT NO./V PERMIT NO
BLOCK TRACT f0 S�p/ INDUSTRIAL
f WASTE APPROVAL
SIZE OF LOT
C,x/ NOW ON LOTS- / CHARGE
USE OF• /C�
BUILDINGS CONNECTION CHARGE FEE
NO. DESCIRIPTION OF WORK FEE REIMBURSEMENT FEE k'
�J HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 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 NO
ALTER OR REPAIR EXISTING I D\E BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND
_ AND/OR DISPOSAL SBYSTEMN SEWER 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION '74'/O,- 7 DEPTH 49' --
SPECIAL CONDITIONS ONLY 200 / ANHOLE REFERENCE
��Q♦ {Y/V,_ LBP.ER� LOWER;�
TYPEOFC RB�ECTION LENGTH
TOP FR FROM
- OWNERS PERMIT $ I I 00
AUTHORIZATION I TOTAL FEE .�
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 /
SIGNED THIS..__-I_.�-- 0F. L`t�-1. 19 NEW HOUSE SEWER 5GA �`�2�
OWNER OR CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT-. -4^' `T!`.v�/ _1.3 Y
SEPTIC TANK,-SEEP:PIT($)
ADDRESS _ .b7,.�y....�_ _Y_f L�. V ��C.. IL.�._ AND/OR DRAINFIELD Y
1 HEREBY ACKNOWLEDGE THAT 1 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 DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABO�_ _BE_D..R_ES.1
DENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNTURE SEEP PIT(S)E] CESSPOOLS E5- 5
OFP ERMITTE - - ------
76AG42A 663 7/53 /Ac—