HomeMy Public PortalAbout10148 OLIVE ST_Sewer__ 12[11115E CITY
6F.
8- 2
6A4ZD APPLICATION/ FOR PERMIT �
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coiJENT OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING - 7 �}
J[�HN A. LAMBIE, County Engineer ADDRESS 101 8._E. Olive
WILLIAM A. JENSEN, Sup't of Building LOCALITY Tom»�ple City it - — -
REST
FOR APPLICANT TO FILL IN CROSS _s___------
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"JESCP PTION LOT NO , _ OWNER_�{'WF�r;
✓ �,} MAIL -
BLO-,K TRACT /��' f Y �" ADDRESS NO. OFBLDG Of [..OT NOW ON LOT CITY 7E''-I.. NO.
USE OF
e ':LDINf S' Res & Gar4 DISTRICT NO, G'POIi!=. MAP PRO ESSEXD BY
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CONTRACTOR Square, Deal Sewer Service � -
D!: E 133 J,d -f-� ---� CONNECTION DATA - ----
7 Y l _.t'�oilte TF AO(rGI 4""l.+2w.0 �A STATION ;r � Z r DEPTH
[7 STATE
MANHOLE FE R€NCE f
E, ., i - _
REGISTR4'ION NO. COUNT / /
J2887-0
Na DESCRIPTION OF WORK FEE _ _--
--�- `TYPE O'F CONNE 70S^1 LE'fiGS+i.¢h'OIYp
i
HOUSE S W 2 CONNE TfNG TO -_-- - Y CURB P L M.L TO P
•PJB[[C SEWER $5.00 !0 --. — _.__ ;rk__ _— 0
' SEP P'6C TANK,SEEPAGE PIT OR I �' JOB NO
PITS AND OR DRAINFIELD @ ¢70.00 C6.IMP NO !
House:SEhfEh CONNSt T1 CIG 10 TRUNK.PF RM'!'r NO ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAitiER EA`EH Lh RECORD INSTP NO.
WORK TO HOUSE SEWER f $3.00—
iOVERFLOW SEEPAGE PIT,SRA N1£L.D
EXTN -L5SPOOL,DRYWELL,MANHOLE Q $5.00
HW'Y, 011 ST.WIDENING
..I A..fER.REPAIR OR ABANDON HOUSE ---
SEWER ORD I'PCSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PEM!T NO.
INDUSTRIAL
WASTE APPROVAL
_-._—___._-._.._._.__._-_..__-1._.—._-_T..._.___.
CHARGES
OWNS. s I'EIIMIT z' Go --- — — --- ---
-_.____ CONNECTION CHARGE FEE
AUTHOMATION TOTAL FEE _ --- -- —
! HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REf_M BU RSEME_NT-FEE
CON-
T
TO C('�NNECT THE ABOVE. DESCRIBED EX!ST,NG L ELLING -- APPLtiB'tl Ala - -- -- — ----
TO THE -UBLi SEWER. _ - DATE—�IN$PEC70R S SIGNATURE
R'F..
SIGNET 7NIs -
O`NNER NEW HOUSE SEWER -
OWNERS AGENT—
-,,�`. CONNECT ADDITIC NAL
ADDRESS n - _ BUILDING OR W'ORt
SEPTIC TANK SE-P.PIT(.5) 1
I 'HLUF-RY AC: NOWLEO C THAT I HAVE READ THIS APPLICATION AND!OR DRAINFi`r i.G j
AND STATE THAT THE , SOVE IS CORRECT AND AGREE. TO COMPLY
W IT AL'_ COUNTY ORDINANQVS AND STATE LAWS REGULATING
i'UMCING AND SEWERS, CESSPOOL L UR.YWELL
t HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPA.[R.SEWER OR
LtCEN_-0 AS REQUIRED BY LOS ANGi.ES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
GA_SP ORft•.A OR THAT I AM THE LEGAL aWNF f}F ANU INTEND T6 DISC ON NCCT PLUG AND 1
RESIDE IN, THE. ABOVE DESa;Ri yBED RE:SSCEN' AL ROPERTY. ABANDON HOUSE SEWER I
I !A _
OF r ERM'T7 FE BACKFILL L:SEPTIC TANKS IL
,S
EEP',PIT(S) [�' CESSPOOLN}
VALIDATION ROBERT A. WOOD
CK. M.O. CASH
SUPERVISING MECHANICAL ENGINEER
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