HomeMy Public PortalAbout10105 OLIVE ST_Sewer__ 24650 INSERTS
ckeoes-so APPLICATION FOR PERMIT i
�aaeazD COUNTY OF LOS ANGELES .SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING -
ADDRESS
ICHN A. LAMBIE. County Ergsneer
WILIIAM A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS Si-.
LEGAL - - OWNER ..'
DESCRIPTION LOT NO.
BLOCK TRACT MAIL, -
ADDRSS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS _ DISTRICT NO. GROUP MAP PRrRCESSfD BY
BK PG 1
CONTRACTOR �r y
yay-1
ADDRESS CONNECTION DATA '
CITY ` TEL.NO. STATION DEPTH 10 .
r
'. ON ❑ STATE MANHOLE REFERENCE
REGISTRATION N0. C] COUNTY V
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEVER @ $3.00 ,I TYPE OF CONNECTION LENGTH FROM!
SEPTIC TANK SEEPAGE PIT OR t Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFiELD @ $3.00
OVERFLOW SEEPAGE PIT,�DRAINFIELD � -
_.Y,,N.. CESSPOOL. DRYW.__ $2.00
HOUSE SEWER CONNECTING TO --P.C,NO.
PRIVATE DISPOSAL SYSTEM $1.00 CO.IMP. N0, JOB NO. -
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO, ROAD PERMIT NO. Tt Q
WORK TO 14OLSE SEWER Y U
ALTER. EPA,R OR ABANDON HOUSE STATE ENCROACHMENT �
SEWER:OR DISPOSAL SYS7E.M @ $1.00 PERMIT NO. O
INDUSTRIAL
Vv"ASTF APPROVAL W
Ss
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE I` REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ! D� ATE 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. PIT(S)
AND/OR DRAINFIELD _
I HL•RVBY ACKNOWLEDGE THAT 1 -HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ElDRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER DR
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 THAT I AM THE LEGAL OWNER OF'THE ABOVE — -
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS [}
SIGNATURE 'µ SEEP.PIT(S) L.! CESSPOOLS
OF PERMITTEE
VALIDATION ROBERT A. WOOD
CK ; M 0. CASH SUPERVISING MECHANICAL ENGINEER
V a