HomeMy Public PortalAbout10206 OLIVE ST_Sewer__ 1v
CE808 20
76A 6420/7APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL Li
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE. COUNTY ENGINEER ADORES
COLEMAN W. JENKINS, SUPT. OF BUILDING
LOCALITY
LI
DDR
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NEAREST
FOR APPLICANT TO FILL IN CROSS S1.
(PRINT OR TYPE ONLY)
OWNER
-��RIIPTL�ON LOT NO��
DESCRIPTION
AIL
A ODRESS
FOR
TRACT M
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OF BLDGS 4,
5 7,
SIZE OF LOT P1 NOON LOT CITY
USE OFr. DiSTRic'r NO.[GR&'�P CLASS 4A P — ESSED By
BUILDINGS
BK PG
CONTRACTOR < J
CONNECTION DATA
ADDRESS
C! TEL. NO. STATION DEPTH
LIPPER
LIC MANHOLE REFERENCE
0 R
L LASS R
46 "? -3 �11
STArE
LICENSE NOIJ
NO. DESCRIPTIONOEWORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO ;,7 Y. CURB P L.) M.L.TO P.L.
P C.NO.
SEPTIC r---K SEEPAGE PIT OR Co. IMP. NO. JOB NO.
D,OR DRAINFIELD
PUBLIC SEWER $5.00
PITS AN $10.00
HOUSE SEWcR-C-DN-NE�CTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIV.ATEDISPOSAL SYSTEM
@ $3.00
C)
---iT RECORD.IN�3TR.NO. I
CONK CT ADDITIONAL BLDG.OR DAVIT WAIVIN i EASEME1 DATE
TO HOUSE SEWER $3.00
OYER FLOW SEEPAC EPii�.
EXTN P CL.DRYWELL.MANHOLE @ S5�00
!�Ep" — HWY. OR ST,WIDENING
ALTER.REPAIR ORABANDOWHOUSE 0
F-
SEWER OR DISPOSAL SYSTEM SYSTEM. $3,00 STATE ENCROACHMENT
PERMIT NO. Lu
INDUSTRIAL on
WASTE APPROVAL
z
CHARGES
OWNER'S PERMIT 7,-* 00
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 47 1 r C", _
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONREIMBU-
T EXISTING
'WELL
T C 14 NECT THE ABOVE DESCRIBED DWELLING. -
0 CONNECT
To THE PUB L iC SEWER. APPROVALS DATE, INSPECTOR'S SIGNATURE
-SIGNED TH!S---DAY OF-19—
OWNEROR NEW HOUSE ____ _
OUSE SEWER__ __
OWNERS AGENT-----
CONNECT ADDITIONAL
ADDRESS— BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(s)
I HEREBY ACKNOWLEDGE THATHAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS C1ORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES, AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL 0 DRYWELL E]
I HERESY CER!11"Y THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS LES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA 0 THAT I AM THE L, GAL OWNER OF. AND INTEND TO PLUG AND
RESIDE IN THE ABOVE DESCRI 40 OFSIDENTIAL PROPERTY, ABANDON HOUSE SEWER
S;GNA7URE
OF PERM FT7 EE6/"-'-' 11A C 11 F'1�1L-SEPT
IC
TANKS
CESSPOOLS
VALIDATION,--_ -, JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK. M io /CASH
c! 77 2 6 1-