HomeMy Public PortalAbout10009-10011-10015 OLIVE ST_Sewer__ CE+30i8II1.37 APPL.IGATIbN F=OR PERMIT
COUNTY OF LOS ANGELES SLkER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ; n
JOHN A. LAMBI€, Country Engineer ADDRESS /
CASSATT D. GRIFFIN, Supt of Building
LOCALITY :EL,
FOR APPLICANT TO FILL IN CROSSSTLEGALDESCR[PTlON LOT NO ,�,,'�a. .�. , OWNER ,f AL_.r° !, .MAIL
BLOCK TRACT ADDRESSNO OF BLDGS.SJZE OF LOT NOW ON LOT CITY r F NO. -
USE OF'
EUILDiNC,_ - DISTRICT NO. _GROUP MAR
r – �K PG_
CONTRACTOR
ADDRs ssW `f ' ILI,' :, ..v CONNECTION DATA --
CITY x - _ TEL.NO.,( ,,X. A �'•`�.. STATION DEPTH
R'i
e k.,,. �. �' .:7,' '_.STAT.E MANHOLE REFERENCE _- UPPER
REGISTRATION No.,* [1 COUNTY LOWER
NO, DESCRIPTION OF WORK FEE --
HOUSESEWER CONNECTING"O
PUBLIC SEWER (u' $34 —'
sl SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
I PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
�OYERP'LOW SEEPAGE PIT.DRAIUFIELI)
EXT_N.:_CESSPOOL,DRYWELL,MANHOLE @ $2.00_C
HOUSE SEWER CONNECTING TO P.C.NO,
_ _PRIVATE DISPOSAL SYSTEM_ co, $1.00 uo0 IMP.N0. JOB NO.
CONNECT ADDITIONAL BLDG.OR - ---- ----
( WORK TO HOUSE SEWER @ $1.00TRUNK PERMIT NO. ROAD PERMIT NO,
ALTER,REPAIR OR ABANDON HOUSE - - _ -- - -
SEWER OR DISPOSAL SYSTEM G $1.00 STATE ENCROACHMENT
PERMIT NO.
- INDUSTRIAL
WASTE APPROVAL —
CHARGES
OWNER'S PERMIT s �--� 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE � f c
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS { DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER, — --
SIGNED THIS —DAY OF— _9 9_ NEW HOUSE SEWER
OWNER OR '
}' CONNECT ADDITIONAL
OW NERS:AGEN'T _2LLe_ .^.--., BUILDING OR WORK _
ADDRESS~ _ SEPTIC TANK,SEEP,PIT(S)
— -
- _AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION T
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL r_� DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
.PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE_ LEAAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDEL,A.L PROPER +�, a BACKFILL SEPTIC TANKS❑El'F „, SEEP.PIT($) CESSPOOLS
OF PERM ITTE ,�� ar c
�d VALIDATION- ROBERT A. WOOD
CIS. mt Q. ; CASH SUPERVISING MECHANICAL,ENGINEER
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