HomeMy Public PortalAbout10631 OLIVE ST_Sewer_2/13/1962_HOUSE SEWER CONNECT TO PUBLIC SEWER GA642D$1 APPLICATION FOR PERMS I.T �';
COUNTY OF LOS ANGELES
SEWER-SEWAGE DLSPQS�AL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING „bpd
JOHN Ay LAMBIE, County Engineer ADDRESS,
WILLIAM A. JENSEN. 5up't of Building LOCALITY r
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,
LEGAL y y '
DESCRIPTION LOT NO. OWNERz it
.
BLOCK TRACT g MAIL
4, ADDRESS
NO.OF BLDGS. g
SIZE OF LOT NOW ON LOT ✓ CITY TEL. NO
USE OF
BUILDINGS - DISTRICT NO. GROUP MAP PROCESSED BY
SK P6 4
CONTACTOR �j - ✓I L ° �` —--
a"
ADDRESS r CO NECTION DATA
Ci " TEL.HO A ION l- -7� DEPTH
ST
ATE MANHOLE REFERENCE - '-
REGISTRATION NO. .. _4, LJ COUNTY { LLTOWER�
N0. CRIP ION OF WORK FEE -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 C%pc
TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CVR.$ P.L. M.L.TO P,L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD _
XTN..CESSPOOL,DRYWELL @ $2.00 " a
HOUSE SEWER CONNECTING TOCO.IMP.N0. r I ✓� JOB NO.•
PRIVATE DISPOSAL SYSTEM @ S1.00
CONNECT ADi)tTIONALL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0, j/ J !y
WORK TO HOUSE SEWER S1,O0 ,�
Ckt
ALTER,REPAIR OR ABANDON HOUSE. STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO U
INDUSTRIAL d
WASTE APPROVAL N
CHARGES z
OWNER®S. PERMIT g 2 QO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 4" REIMBURSEMENT FEE
I HAVE AT CON-
TRACTOR TO THIS
THE ABOVE DESCRIBED EXIISTINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL _
OWNERS AGENT BUILDING OR WORK
.ADDRESS - SEPTIC TANK,SEEP. T
.PIS)
AND/OR DRAINFIELD
THEREBY ACKNOWLEDGE THAT I HAVE READ 'THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAN I A THE LEGAL gWNER OF THE ABOVE BACKFILL SEPTIC TANKS
DESCRIBED RESID ISP Y. ri
SIGNATURE - '" SEP:PIT(S) CESSPOOLS
OF PERMITT ,.: `�:... .. fff.....'yy�`;!^.."`9.. �
s`VALMATION ROBERT X.'WOOD
Y` cK. Y.O. CASH SUPERVISING MECHANICAL ENGINEER
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