HomeMy Public PortalAbout10158 OLIVE ST_Sewer__ �
S&E-663 f2_54 APPLICATION FOR PERMIT 1
8 Gt
DIVISION OF BUILDING AND SAMY SEWER--SEWAGE DISPOSAL.
Department of County Engineer _
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT p. GRIFFIN,SUPT OF BUILDING LOCALITY
FOR'APPLICANT''TO FILL INnnE5T
CRO.-ST.
LEGAL - -_._,....- ___v__..._._._..._...._�_._..�._.�....____.�.—
DESCRIPTION LOTNO. _- _.� - OWNER
BLOCK TRACT __ ~hiAtL
ADDRESS
NO. OF BLDGS. B `-
SIZE OF LOT NOW ON LOT aP G17Y
�- _w_._____..._.....___. TEL. N0.
^USE OF
BUILDINGS - _ _ DISTRICT NO. GROUP i MAP
5K PG
CONTRACTOR 1 "°id` - -
ADDRESS _ CONNECTION DATA
c1Tt TEL
*;o. STATION �' �� cA' �^ DEPTH � I
r. STATE AMANHOLE REFEPENCE E
REGISTRATION NO. - [I. COUNTY _ v_ LOW-
ER-TYPE OF CONNECTIQ> LENGT FROM 'j 'F
NO. DESCRIPTION OF WORKc^� FEE � �_Y, CURB P L._�� _ M_L..T6 P.L.`•,�T;,,,i�j
HOUSE SEWER CONNECTING TOa7`.
PUBLIC SEWER ce,_ _ $ 3.50 I 3 1� -
I HOUSE.SEWER CONNECTING TO
I_PRiVATE DISPOSAL SYSTEM --
"� CONNECT.ADDITIONAL BLDG. OR CO. IMP.NO. JOB. NO.
WORK TO HOUSE SEWER 4.00 i� _
ALTER. OR REPAIR EXISTING
-___ SEWER OR DISPOSAL_SYSTEM _ 1.00 ��� TRUNK PERMIT NO. ROAD PERI4IT NO. e
DISCONNECT AND ABANDON SEWER -� STATE ENCROACHMENT._ v '- --`-
AND'OR DISPOSAL SYSTEM_ 1:00 -PERMIT NO. 'a
�� SEPTIC i�iNh SE�.PAGE PIT OR
PITS AND OR DR_AINFIELD 2.00.1 I� iNDUSTRiAL
--I CESSPOOL DRYWELL I WASTE APPROVAL --"
_! SPECIAL CONDITIONS ONLY 2.00 ! CHARGES x
`� — --- Y
PERMIT I_ CONNECTION CHARGE FEE-
OWNER'S I CO ._ _-_-
AUTHORIZATION ' TOTAL FEE ---- REIMBURSEMENT FEE
HAVE TATS DATE. CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR APPROVALS - 11d5PEC1'CR'S SIGNA7UR!=
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _- - DATE
-_ _1
TO 'THE PUBLIC SEWER
NEW HOUSE SEWER -
SIGNED TWS_ DAY OF— x._.19 --____
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.::. BUILDING OR WORK
_ SEPTIC TANK, SEEP,PIT(S)
AND/OR DRAINFiELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL"v'
AND STATE THAT THE ABOVE IS CORRECT. AND AGREE TO CO;i PLY ---
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF'
CALIFORNIA OR THAT 1 AM THE LEGAL OWNS OF THE,,ABOVE ABANDON HOUSE SEWER _ a,
DESCR)B•ED RE^SIDENTyppp/,����L ROPERTY BACKFILL SEPTIC TANKS[I tb; & � �`, � SEEP PITS) El CESSPOOLS F,
SIGNATURE +yid
OF PERMITTEE
WILLIAM J. F'OX, LINTY ENG, EER VALIDATION
BY BY
DEPUTY DEPUTY
B Y S Y , +
DEPUTY DEPr'r