HomeMy Public PortalAbout10226 OLIVE ST_Sewer__ a£-663 4f-55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles 7ADDRESS
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JOHN A. LAMBIE, COUNTY ENGINEER ,,"_''. . _.:,
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.'� CASSATT.D.GRIFFIN, SUPT OF BUILDING ��:��r -
NEAREST
_-FOR APPLICANT TO FILL IN _CROSS ST. r,• ' '__
LEGAL OWNER
DESCRIPTION LOT NO. - a
.-' MAIL
BLOCK TRACT -
fjy= N ADDRESS -
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT _ CITY TEL, NO,
USE OF
BUILDINGS DISTRICT NO. GROUP I BK MAP PG
CONTRACTORAi
,
1 µ CONNECTION DATA
ADDRESS ✓� +f a °_��"f✓�. 1' ef1... « _ ----
---, ..� �= ✓.�. « s t., , STATION
DEPTH
CITY jukv
TEL, .
-
MANHOLE REFERENxE _
❑ STATE LQWER
REGISTRATION NO. ✓ ... ✓l '�' eerl Y -- —
NO. j DESCRIPTION OF WORK FEE --- — --
-I-. — ---- --- -- -- - -- TYPE OF CONNECTION LENGTH FROM
hUU E SEWEn CONNECTING TO
r _Y. CURB1•.�r M.L.TO P:L. __---
_�. PUBLIC SEWER C. 3,50 y -- ---
SEPTIC TANK.,SEEPAGE PIT OR — - --
_ PITS AND/OR DR_AINFIE.LD !it $3_._00
OVERFLOW SEEPAGE PIT,DRAINFIELD I .�✓' i.1 � P C NO.
-,---i_EXTN.,C€SSPOOL,DRYW ELL,.t AN HOLE Ca $2.00.1-_- CO.IMP. NO. �-----—.JOB_J NO.`_-
MOUSE SEWER CONNECTING TO --- — - --- ------ _
PkIVATE DISPOSAL 'STEM t3 $1.00 I �.�T. `TRUNK PERMIT NO, ROAD PERMIT NO.
CONNECI-ADDITIONAL BLDG-OR I j STATE ENCROACHMENT
j_ +YORK TO HOUSE SEW ER (r $7.00 i. PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ua $1.00 : _- WASTE APPROVAL
CHARGES
-------- ------------ -_--- CONNECT-ION CHARGE FEE
OWNER'S PERMIT 1 00 - - --- ------------
REIMBURSEMENT FEE
AUTHORIZATION' - TOTAL FEE
__ - l �'
-.1 HAVE AT THiS DATE A CONTRACT WITH THE HEREIN 14AMED COIII- APPROVALS DATE iINSPECTOR'S SIGNATURE
I
TRA,CTOP TO CONNECT THE ABOVE DESOR BED EXISTING DWFULING _
,., (HE PUBLIC SEWER. I - NEW HORSE SEWER
SIGNED TI-I1S _—.DAY C)(- w- -- I9 CONNECT ADDITIONAL
OWNER OR = ''' yr'" y BUILDING OR WORK
OWNERS AGENT W,944,;.i"` ,e .—_ --- -..-- --!-- ---1 -- --- ----
SEPT[C TANK,SEEP, PIT(S) 1 �
ADDRESS_ +�' �! AND/OR DRAIN IE J --
---I HEREBY A KINC-,NLEDGE THAT I HAVE READ THIS APPLICATION
Ar DRYW AND STATE "H;., E . ELL 0
,rdL ABOVE IS CORRECT .ANO AGREE 70 COMPLY C.__..__ 1
SSPOOL_._..-- _-_.._— ---J-._._.—_--..
V I7H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR j
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM-
1 HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AN R T --"-------..—..---._.--
LICENSED As Rf Oi'riAT T5I BY LOSANGELESCOUNTY ST DISCONNECT PLUG AND
�i E VE ABANDON HOUSE SEWER
CALIFORNIA OR ! AV LEGAL OWNER OFF THE' ABOVE
DESCRIBED REST eENT1,AL I RwP.'R-IY -_, :' 3ACKFILL EPTIC TANKS
SIGNATURE
. .r r' SEEP. IT(3i C CESSPOOLS
,. ,� _ ..'. .,..
OF PERMITTEE
IOHN A. LA,7B E, COLJNTY ENGINEER VALIDAT ON ROBEPT A. WOOD, C}iiEF PLBG. INSPECTOR
CASE!
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