HomeMy Public PortalAbout10139 OLIVE ST_Sewer__ E-6D
S§ -63 f5.55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND` SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDINGy
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �rJ�O d
D CASSATT D. GRIFFIN, SUPT OF BUILDING - LOCALITY .
NEAREST
FOR APPLICANT TO FILL IN CROSS Sr.
LEGAL OWNER
LOT NO. '7
AIL
BLOCK TRACT ° ADDRESS
NO.OF BLDGS, :ate, r..�
SIZE OF LOT NOW ON LOT CITY.: ' TEL. NO. J
USE OF GROUP MAP DISTRICT N0.
BUILDINGS _ BK PG
CONTRACTORIj
---�� -- CONNECTION DATA
ADDRESS
CITY STATION ��• — `D-EPTH
TEL. . /y
U_P.P._E-
?MANHOLE REFERENCE
STATE -.
-
REGISTRATION NO, - �� COUNTY
No, DESCRIPTION OF WORK _i FEE_ ------ —_—.—.--_— _
I HOUSE SEVJER CONNECTING TO
TYPE OF CONNECTION . LENGTH FROM -
)))) PU_BLIC_SEVIERL $3.50_I - T --'. —Y` CURB p L M.L.TO P,L.
-
!!!!!!!! SEPTIC TANK,SEEPAGE PIT OR -�
PITS ANDiOP, DRAINFIELD ti $3.00
—_i ---- _------ --- - —---'---�---i--- :' P. C. NO.
OVERFLOW SEEPAGE PIT', DRAINFIELD
_ EXTN.,CESSPOOL,DRY_W_ELL,MANHOLE Tri• $2.00 CO. IMF. NO. �. s ��, 10B NO,
--
HOUSE SEWER CONNECTING TO --- --'�--�---_- --` ---
PRIVATE DISPOSAL SYSTEM $1..03
TRUNK PERMIT NO, ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK To HOUSE SEINER ( $1.00 PERMIT NO.
ALTER,REPA P OR ABANDON HOUSE '---- -----� -----_—
SEWER OR DISPOSAL SYSTEM ��4 1 0, INDUSTRIAL
-- ---- _-_- -_-- _.---—. _i—.-- ----. WASTE APPROVAL
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CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 1 oO ----- --- -- - _---
-- REIMBURSEMENT FEE
AUTHORIZATION -TOTAL FEE--- -�- -�)
APPROVALS
t� i�
'I HAVE AT THIS DATE A C014TRACT WITH THE HEREIN NAMED CON- APPROVALS f DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED ET:ISTING DWEI.L!NG E
TO THE PUBLIC. SEWER. - NEW HOUSE SERER
SIGNED THIS DAY F19-- - -- -- �— -
CONNE('T ADDITIONAL
OWNER OR "`w ,, BUILDING OR WORK
ol..de
OWNERSAGEId - ;1, _____: .---_---._..— SEPTIC TANK.SEEP,PITS} t
r
AND/011DR.AiNrit'..LD
ADDRESS—. --- ------- ...._.._ --._---
s
HEREBY A.CYN `.NLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL EI DRY'WELL EJ —,
AND .TATE Tti40 [HE ABOVE IS CORRECT AND AGREE To COMPLY" ----- ._..___._ --;_-.-----'- --,_--
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS.
SEWAGE DISPOSAL SYSTEM
I
- _
HERPY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - --- ------------ T-�_- —
DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I And THE LEGAL OWNEROf THE ABOVE ABANDON HOUSE SEWER ;
DESCRIBED RESIDENTIAy, ROPERTY, BACKFILL SEPTI TANKSII I I
-SIGNATURE i' '' SEE P{ (5) i..] CESSPOOLS L] ' ----.._ �,------ --
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eF
IT. -
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JOHN A. LAMBIE. UN7Y ENGINEER LIDATI®N ROBERT A. WOOD.CHIEF PLEG. INSPECTOR
0. CA5H - - -