HomeMy Public PortalAbout10127 OLIVE ST_Sewer__ 7a E.66-668 ti.55 F
& APPLICATION FOR PERMIT _
>
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING ,
JOHN A. L_AMBIE, COUNTY ENGINEER ADDRESS � e
a r
GASSAT'T D. GRIFFIN, Su;v'r of BUILDING LOCALITY,
7AL
ILLINEARESTOR APPLICANT TO FILL IN cRoss sT.I OWNERL05' N0. MAILTRACT '`�j `yam ADDRESS
_.b
NO.OF BLDGS. ---
. SIZE OF LOT_J-- NOW ON LOT--- _ CITY. TEL. N
USE OF i
BUILDINGS-- } - -- DISTRICT NO. I. GROUP I MAP
-- — -. -- BK PG.
.CONTRACTOR
ADDRESS s & �__ CONNECTION DATA
-- — STATION �` --- DEPTH
CITY r TEL NO
-- -=-d Ls MANHOLE REFERENCE.
�1
K]t STATE LOtVE±_
REGISTRATION NO. COUNTY. -- -~ -
--
N6_ DESCRIPTION OF WORK _- -FEE TYPE OF CONNECTION --LENGTH FROM-- '�-
HOUSE SEVIER CONNECTING TO _ 1 Y
PUBLIC SEWER - @ $3.50 _.� f-�3-.-CI _y�_____-__ CURB P.L. M.L. 70 P.L. —�
-r SEPTIC TANK,SEEPAGE PIT OR
—� PITS AND/OR DRAiNFIELD () $3.00.I
1 OVERFLOW SEEPAGE P11 DRAINFIELD II P C NO.
-' EXTN.,CESSPOOL,DRYWELL,MAN HOLE (q), $2.00! ._. CO. IMP_N0 _ -10B NO.. ----------____.-
HOUSE SEWER CONNECTING TO +
PRIVATE DISPOSAL SYSTEM (+ ?;.1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR I STATE ENCROACHMENT '
WORK TO HOUSE SEWER /(r $1.03 _ PERMIT NO.
INDUSTRIAL
j
ALTER,REPAIR OR ABANDON HOUSE _ - ---^------ -—
SEWER OR DISPOSAL SYSTEM - (c $1.00 WASTE APPROVAL
i
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT 1 00 --- -- ___.__—_--.---- _--
---- —"-� — - -- REIMBURSEMENT FEE
TOTAL
TAL /moi'
L
( HAVE ATTHIS DATE A CONTRACT WITH TH£ HEREIN NAMEDCON- APPROVALS DATE 1INSPECTOR SSIGNATUP.E
!TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
70 7H£ PUBLIC SEWER. - NEW HOUSE SEWER I.
SIGNED THIS AY 0 I9. CONNECT ADDITIONAL
OWNER OR -- BUILDING OR WORK
'k..Ly�,:4J't,.�. , .� ..
OWNERS kGENT_ - _.�'�... ----- SEPTIC TANK,SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOW EDGE THAT I HAVE ,LEAD THIS APPLICATION CESSPOOL❑ DRY'AELL❑ 1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING
ALTER REPAIR,SEWER OR
PLUMBING AND SEIWERS SEWAGE DISPOSAL SYSTEM _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/'OR -- - ----- ---- -- -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
ABANDON HOUSE SEWERCALIFORNIA OR THAT I °,.M THE LEGAL OWNER OF THE ABOVE. - I-- ---j ------
DESCRIBED
--DESCRIBED RESID.E'NTIAL Pi 9PEP'Y. BACKFILL SEPTIC TANKS El
SIGNATURE '✓ <> � SEEP. PITS) Q CESSPOOLS❑
OF PERMITTEE _-- ------ice----- ---
I
IOHN A. L.ANI'SIE. Cg NTY ENGINEER VALIDATION IRO.BERT A.WOOD, CHIEF PLEIG, INSPECTOR
CG! i9.G. CASH -