HomeMy Public PortalAbout10034 OLIVE ST_Sewer_9/1/1955_ - 7aE•5-6D63 12-54 APPLICATION FOR. PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County o4 Los AngelesaU'LO D. SG .%
WM.J. FOX. COUNTY ENGINEER
CASSA.TT G. GRIFFIN, SUPT or BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. -`l4
LEGAL '-
DESCRIPTION OWNER
^BLOCK TRACT yl fi.�, MAIL
ADDRESSf6"...E:i4 .t_.
NO. OF BLDGS.
_SIZE OF LOT NOW O_N LOT CITY TEL..NO.
USE OF —
BUILDINGS_ DISTRICT NO. GROUP MAP
SKPG,..
CONTRACTOR
ADDRESS a. ' CONNECTION DATA `
CITY. ..TEL. NO. _A_ STATION �.'` ^'T.._ '>,..^ DEPTH f -
�
K STATE :
-,•-, "` - _ ,r' l✓ y MANHOLE REFERENCE
REGISTRATION.NO. COUNTY �, ,f„t"-� UPPER
-" - TYPE OF C16NNECTIOy _-- LENGTH FROM
No. 1 DESCRIPTION OF WORK FEE Y. CURB P.L.'. _ W_L To P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0
_____�_ $ 3.50 B:
HOUSE£EWER C0NNEH IN TO —
! PRIVATE DISPOSAL SYSTEM
CONNECT ADDi T, 1.ELDG. OR ---__ .7
WOR
CO, IMP. N0. r' JOB. NO.K 70 HOUSE SEWER i.00_! � C v -i
ALTER OR REPAIR EXISTiNG-� g--a•- --------
ul
SEWER OR DISPOSAL SYSTEM 1.00_ TRUNK PERMIT NO, ROAD PERMIT NO_
DISCONNECT AND ABANDON SEWER ! STAT£ ENCROACHMENT
DISPOSAL.SYS.EM__ 1_._00 1 — PERMIT NO.
--
SEPTIC TAN.K, SEEPAGE PIT OR --- _
DRP I 00
_NF 2. INDUSTRIAL
P175 AND'OR E4D
CESSPOOL- DRYWELL—_- — — WASTE A-PROVAL
SPECIAL CONDITIONS ONLY 2.00_J CHE$
._`i.---`- - --- --- - .� —
CONNECTION CHARGE FEE
OV�I°F£R'S PERI�ZIT _ $ i
AUTHORIZATION TOTAL FEE �.'I '� REIMBURSEMENT FEE
i
HAVE THIS DATE CON""RACIED WITH SHE HEREIN NAMED CON= RO Tom+
TRACTOR -0 GONNEC'C THE ABOVE DES. IEED EXISTING Da. LLDa. LLIr.,G APPROVALS DATE `! ITd5�'EC ORS IGN,�7 iiRE
TO THE PUBLIC EWER -----�
1
SIGNED THIS .rDAY OF ]�,`� NEW HOUSE SEWER - -- — --.�-----_ ��
OWNER OR J CONNECT ADDITIONAL
? BUILWORK
C'xYNERS ASSENT -:y'._ _BUILDING OR._.- _ -
pDDR _S_ 3 !� SEPTIC TANK, SEEP. PIT($)
_.. _AND/OR DRAINFIELD _
I HEREBY ACKNOIALEDGE 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 LASS REGULATING ALTER, REPAIR,SEWER OR
PLUMB6NG AND SEWERS. _SEWAGE DISPOSAL SYSTEM _
I HIiRERY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY L ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR -THAT I HE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIEED RESiDENTIA P€RTY, BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) O CESSPOOLS
SIGNATURE _ _ —� - - - -
OF PERMITTEE
WILLIAM J. F COUNTY ENGINEER VALIDATION
D r7
BY
DEPUTY DEPUTY -..
BY BY
-T) DEPUTY - DEPUTY