HomeMy Public PortalAbout10124 OLIVE ST_Sewer__ 24650 INSERT
6A
642.60
7£A&42A APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING x
ADDRESS
IOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAREST '-,1 _
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT NO, -
BLOCK TRACT � MAIL
ADDRESS `
NO.OF BLDGS. cF
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
f BFC PG
CONTRACTO '
' 'f )v
ADDRESS CONNECTION DATA Y
CITY t TEL.N0, �' STATION .'- DEPTH a � '
a'S✓
STATE MANHOLE REFERENCE - —
REGISTRATION N0. ,� COUNTY '`,'��. `d ✓LOWER
NO. I DESC:Rt T ON'0 ORK FEE
HOUSE 5 We R CONNECTING TO
PUBLIC SEWER cc% $3.00 &> TYPE OF CONNECTIO1�i�' LENGTH FROM c' e-
SEPTIC TANK.SEEPAGE PIT OR — t', CURB P% M.L.TO P.L.
PIISAND/ORD.RAINFIELD @ $3..00
OVERFLOVl SEEPAGE PiT. DRAINFIELD
i EXTN„CESSPOOL.DRYWELL 52.00
I
HOUSE SFINER CONNECTING TO P.C,N0,
PRIVATE DISPOSAL SYSTEM @ S1.00 CO. IMP.NO. "- P.
JOB 10.
CONNECT ADDITIONAL BLDG,OR TRUNK PERMIT NO. ROAD PERMIT NO. O
WORK TO HOUSE SEWER ( $1.00 U.
1 Al.TER, RE A.IR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAi,SYSTEM @ $1.00 -PERMIT.NO-
INDUSTRIAL -
0
WASTE APPROVAL (,.7
W
_ CHARGES dr
OWNERS PERMIT $ 2 0000 CON14CCTION CHARGE FEE
AUTHORIZATION TOTAL FEE I I REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS dJATE NNSPE'TOR`SSIGNATURE.
TO THE PUBLIC SEWER.
SIGNED THISAY OF 19_ NEW HOUSE SEWER
r CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PITS)
-- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT") HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL ❑
WITH ALI. COUNTY ORD)NANCES AND STATE LAWS REGULATING J—
PLUMBING AND SEWERS. ALTER,REPAIR.,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDE 'AL PROPERTY, BACKFILL.SEPTIC TANKS
SEGNATURE. �"-.
,� SEEP. PITS) 0 CESSPOOLS [j
OF PERMITTEE
VALIDATION ROBERT A. WOOD
CK. K.A. /CASH SUPERVISING MECHANICAL,ENGINEER