HomeMy Public PortalAbout10103 OLIVE ST_Sewer__ 51.55
76AF-66 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING p
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESSo
E —
CASSATT D.GRIFFIN, SUPT or:BUILDING, LOCALITY '
-_—FOR. APPLICANT TO FILL-IN — CROSS sr
LEGAL
DESCRIPTION LOT NO. :F OWNER
LI A l L -BLOCKTRACTTRACT _ ADDRESS
r_.' NO.OF BLDGS• I= d, .�s;- fh'`1TY 't -. - � E'.CP� ,., `^
SIZE OF LOT ate. �. �F NOW ON LOT TEL. N0.
USE OF
BUILDINGSt( .�- .� _ DISTRICT NO. GROUP MAP
_ BK. PG
CONTRACTOR y^ t
C®NNECTI®N DATA - ---
ADDRESS •• .— ,.w-°' X yx._ y � -- - - -- - --- --- --
-_ F"� l" `TATION DEPTH
CITY TEL. NO'. ` -- - ---- ------
MANHOLE REFERENCE yUPPER
'may lei STATE - LOWER
_REGISTRATION NO. ! >✓'y ❑ COUNTY --�— — '~. ---
DESCRIPTION OF WORK FEE -- ------
TYPE OF CONNECTION - LENGTH FROM
HOUSE SEWER CCINNELTING TO — �Y, CURB P.L.- M.L.TO P.L.
_ —PUB.LIC SEWER C $3,50 — -- --
SEPTICTANK,SEEPAGE PIT OR �.
PITS AND/OR DRAINFIELD (n' $3.00 -------------------.----__—___
OVERFLOW SEEPAGE PIT,DRAINFIELD j i P. C. N0,
EXTN.,CESSPOO L,DRfWELL,MAN HOLE U $2.00 :O, IMP, N0. 108 NO.
! HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM c�._$,1.0u TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR A STATE ENCROACHMENT
WORK TO HOUSE SEWER $1.00 ! PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM rr: $1.00 I WASTE APPROVAL
�T.-..--------------- --+---- CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT t o - ---- --- ---------- --
_ _ � _0
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE "el
I HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- - APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWED, NEW HOUSE SEWER ,
SIGNED THIS DAY OF__�� ._' = 19�__' CONNECT ADDITIONAL
OWNER OR }.• �,. E UILDING OR WORK
OWNERS AGENT i li
� f1 •'?' cf'PTIC TANK,SEEP PITS)
FND_/OR DRAINFIELD_
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THOS AFPLICA"C ION CESSPOO.,I,_] CR fW F'LL[] 1
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -A.LTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL_S_YSTE_M
I HEREBY CERTIFY THAI' 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND � �—
LICENSED AS REQUIRED BY LOS ANGELES CO TY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM Ty.f LEGAL Q N OF THE ABOVE -- DON HOU- --- �—
DESCRIBED RESIDENTIAL PROP. Ft TY BACKFILL SEFTIC TANKS E
ff ; i
SIGNATURE , SEEP'. PIT(S)0 CESSPOOLS CJ �
rN
A. LAMBIF.Cou Y ENGINEERir'ALID ,TION ROBERT A. WOOD,CHIEF PLBG. INSPECTOR
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3 1 t; 9 X t .