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HomeMy Public PortalAbout6649 CLOVERLY AVE_Sewer__ APPUCATMN FOR RMIT S,&E-883 11-55" � ' DIVISION OF 13UILDING AND SAFETY SEWER—SEWAGE ®O S P®SA L _ Deportment of County Engineer County of Los Angeles BUILDING ` '1�•y. JOHN A. LAMBIE, COUNTY ENGINEER " ADDRESS c� ® CASSATT-D. GRIFFIN, SUPT OF BUILDING , -LOCALITY FOR APPL C„N O.,- cces1 LEGAL iNba IV I Ivy .OWN DESCRIPTION LOT-NO. ER S MAIL BLOCK TRACT ADDRESS N0. OF BLDGS. CITY TEL. NO. SIZE OF LOT NOW ON LOT BUILDINGS OF DISTRICT GROUP, MAP . G CONTRACTOR , y CONNECTION DATA ADDRESS -1ye Age, `e i © STATION ® DEPTH •CITY TEL. NO, MANHOLE REFERENCE . t4 STATE /Q u REGISTRATION NO. w ❑ COUNTY No. DESCRIP ION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO ' LENGTH FROM / O PUBLIC SEWER @ $3.501 ,` - P•L• M.L.TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 .? OVERFLOW SEEPAGE PIT, DRAINFIELD _ Z[�a P. C.,NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE c@i $'2.00 - CO. IMP. NO. l) J JOB NO. HOUSE SEWER CONNECTING TO uPRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO.. ROAD PERMIT CONNECT ADDITIONAL BLDG.OR STATE ENCRO MENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. .ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER,OR,DISPOSAL SYSTEM u $1.00 - WASTE APPROVAL ` rj CHARGES �, CONNECTION ARGE FEE - "A' OWNER'S PERMIT $ 1 00 Jr ` REIMBURSEMENT FEE - . ..`AUTHORIZATION TOTAL FEE [� �.�'1 HAVE AT,THIS DATE A CONTRACT'WITH THE HEREIN MED CON- APPROVALS: 'DATE INSPECTOR'SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING , TO THE PUBLIC SEWER. NEW HOUSE SEWER 'SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR ,� t BUILDING OR WORK OWNERS"AGENT a.�fFi9'CsA.efl "w� SEPTIC TANK,SEEP, PITS) ADDRESS - AND/OR DRAINFIELD I HEREBY.ACKNOWLEDGE THAT I 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. x, SEWAGE DISPOSAL SYSTEM I HEREBY.CERTIFY THAT I AM DISCONNECT PLUG AND PROPERLY REGISTERED AND/OR ' LICENSED AS REQUIRED BY. LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE r DER ESCRIBED RESIDENT IA PROPERTY. ° SEEP.FPIT(S)P❑CESSPOO❑LSK 149.9 z 6&q "'�V- '' SIGNATURE � • OF PERMITTEE a .JOHN A. LAMBIE. COUNTY ENGINEERVALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK, M.O. ASH r Cal. 7 2 5:- -OCT 2 64: :p