HomeMy Public PortalAbout10111 OLIVE ST_Sewer__ 5A -6E3 11.55 D
3 E APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
- Department of County Engineer
County of Los Angeles BUILDING y
JOHN A. LAMBIE,COUNTY ENGINEER _ADDRESS
® CASSATT D.GRIFFIN, SUP'T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO._ OWNER - - -
- �,Z_ MAIL
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BLOCK TRACT _ADDRESS -�
N0.OF BLDGS, /' CITY T€1.. N0. r
SIZE OF LOT N04V ON LOT O
BUdLDNGS�. DISTRICT NO. GROUP ' MAP -
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CONTRACTOR ,,•j _ -{ -� N „J iv
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CONNECTION DATA
ADDRESS
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i( STATION ;�8 ,�.°r: .�' DEPTH _
CITY TEL. NO. t
7 MANHOLE REFERENCE i &�'•
. STATE _ 4 LOWER
REGISTRATION N0. COUNTY - _---NO. 1 DESCRIPTION OF tVORK FEE -- ----- ---- ----
�- -- — ---- --- - TYPEOF CONNECTIOft LENGTH FROM
HOUSE SEWER CONNECTING TO ';, I Y. CURB P L M.L.T ✓ �f.../�
PUBLIC SEWER - --@$_3.5U — _ O P.L. -
I SEPTIC TANK,SEEPAGE PIT OR + 'I
j PITS AND/OR DRAINFIELD _ $3.001
OVERFLOW SEEPAGE PIT DRAINFIELDP. C. N0.
EXTN`;CESSPOO_L,DRY_WELL,M_ANHOLE $2.00 _CO..jMP. NG. JOB N0. _ -
y HOUSE SEWER CONNECTING TO - —�
-._ —
PRIVATEDISPOSAL SYSTEM ca, $1.00 ? �_- TRUNK PERMIT NO. ROAD PERMIT'NO..
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
-- ! WORK TO HOUSE SEWER Com_.$1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSEI
- ------
SEWER GR DISPOSAL SYSTEM Rz. $1.00 WASTE APPROVAL I
i _--- WASTE AOVAL
r
CHARGES
---.—_-----� —_-. CONNECTION CHARGE,'F.EE
� a0 -
OWNER'S PERMIT
,
--- REIMBURSEMENT FEE '
AUTHORIZATION TOTAL FEE
v APPROVALS I DATE �'INSPECTOR'S SIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �I
TO THE PUBLIC SEWER. NEW HOUSE SEWER -I
SIGNED THIS .DAY OF fiQ_— - - ----� �� �.
CONNECT ADDITIONAL
OWNER OR w,£' a'l '.�� BUILDING OR WORK
O".V'NERS AGENT �._��_� SEPTIC"IANK.SEE Pi'I(S)
- AND/OR DRAINFIELD
ADDRESS--- --- -- - .-.. ---iL -----------------_.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONr I`
CESS PCOL, 1 URYW CLL
AND NATE THAT THE ,?60VE IS CORRECT AND AGREE TO COMPLY
w TH ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING ALTER,REPAIR SEWER OR —j
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ---- --- --'--�_---'---_� ---
DISCONNECT PLUG AND
LICENSED AS PFQuIR'=U BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER I '
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE --- - - - -- -- -- -
DESCRIBED RE° DENTIA PROPERTY -„ BACKFILL SEPTIC TANKS I_1
SIGNATURE /' ' SEEP NT,S)_L)_cE_SSp0OL5 OF PERMITTEE
JOHN A. L.AMBIE, G LINTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF F'L.HG INSPECTOR.
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