HomeMy Public PortalAbout6644 CLOVERLY AVE_Sewer__ 76AS420 /rel P P��`�/(/tel II �®I!V, FOR 11 P 'E R o�7�1�T .
S&E-883 11-55
DIVISION OF BUILDING AND SAFETY S E W E R—S MAGE DISPOSAL
Department of County Engineer, p e
County of Los Angeles BUILDING
JOHN A.'LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
o-FOR APPLIC NT TO FILL IIV(„y "Foss sr.
LEGAL °
DESCRIPTION LOT N0. ��_� - .OWNER -
<-+ _MAID
BLOCK ADD
- RESS
SIZE OF LOT �� 7,3. 6 NOWOONBLOTS
CITY .TEL. NO. t
USE OF - DISTRICT NO. GROUP MAP
1 BUILDINGS
BK
CONTRACTOR '
CONNECTION DATA '
ADDRESS
STATION pG., DEPTH git gg;
.' CITY TEL. N l e MANHOLE REFERENCE//// �/y7
STATE O0?—
REGISTRATION NO.J-4'- `J ❑ COUNTY
NO. DESCRIPTION OF WORK FEE - '
HOUSE SEWER CONNECTING TO �{ TYPE OF CONNECTIOIJ/ LENGTH FROM
PUBLIC SEWER @ $3.50 S� P.L. M.L.TO P,L.
SEPTIC TANK,SEEPAGE PIT OR .
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD �7 �� P. C.
COIMPNON0.
EXTN.;CESSPOOL,DRYWELL,MANHOLE @ $ 2.00 . . . (,5 10B N0.
HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL SYSTEM a $1.00 _TRUNK PE IT NO.' ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCRO MENT
WORK TO HOUSE.SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSALS YSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CH GE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION. TOTAL FEE b
- 1 HAVE AT THIS'DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -t
? TO THE PUBLIC SEWER. NEW HOUSE SEWER
ss�� A
SIGNED THIS ri^3 DAY OF CONNECT ADDITIONAL
OWNER OR ` BUILDING OR WORK -
OWNERS AGEN, - SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD - -
I HEREBY ACKNOWLEDGE THAT I HAVE EAD THIS APPLICATION CESSPOOL❑ DRYW ELL❑
AND STATETHAT 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR •
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWDISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDEN L PROPERTY. BACKFILL SEPTIC TANKS❑ _ /� -
'SIGNATURE SEEP.PIT(S) ❑ CESSPOOL Q. 1 /-
OF PERMITT
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. R. 0. CASH
1 1 7 2 4.- "ccT26 - . 4 4.5
�'.