HomeMy Public PortalAbout10227 OLIVE ST_Sewer__ z a 9-663 3 b5 APPLICATION FOR PERMIT
DIVISI®N OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angelos BUILDING
WAR.J. FOX, COUNTY ENGINEER ADDREss
1 CA55ATT D. GRIFFIN,SUPIT OP BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
cguss sT.
=t DESCRIPTION LOT NO, OWNER'
BLOCK TRACT _ htA1L.
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ADDRESS
NO. OF BLDGS,
SIZE_OF LOT NOV! ON LOT CITY TEL: NO.
USE OF
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BL` _ -
'- DISTRICT No. j GROUP �. 'NAEP
PK FG
CONTRACTOR �.° _ ''' --'L'- .- — `� t .r ✓ y-1_�.
ADDRESS CONNECTION DATA
YCITY ^.- rEL. NO -'-'-- --. - STATION v �� DE?IH k:'
STATE MANHOLE REFERENCE
REGISTRATION No. ? ' � �.f "� � COUNTY
DESCRIPTION OF FORK FEE
TYNE 0 CONECTi ON N ' LENGTH FROM .
I
EMU:SE EWER CONI TING Y..- - C.UR - �P L P L. TO P L. ..
PJBLIG 5 PIER C✓'. ,$ 3 6 '� �_:. .-._____-_.-_��..._ _. .�.._- __
HOUSE SEVER CONNE&HiG TO I
PRIVAAE DISPOSAL SYSTEMtICONNECT ADDITIONAL ADDITIONAL BLDG OR � ! ,� C _�,r P. r. T O - r
10RK 10 hJDSE SEWER 1 0U I -..CO. I& N0. Y- A � > JOH 10.
ALTER OR REPAIR EXISTIN.,
EINE OR DISPOSAL SYSTEM _ i Ou TR ut4F P ERM1r N.0 RO?D PGRM1T N0.
DISCONNECT AND ABANDON SEWER-
AND/OR DISPOSAL SYSTE.M .� ___• 0.' _.._ STATE tVCPO-.
AGh, ENT
PERMIT NO
PE lIC:TANK,SEEPAGE PIT OR ----J_---__—�—
TS ANIVOR DRAINFLD INDUSTRIA -- ----_—__
�
APPROVAL
F 3 Adv RY 1 ELI _ _—
SR'C:CIAL CUE,OAT ICNS ONLY
2.00 _ C I I A RG ES .
- - -- �"-- CONNECTION CHAR3E FEE '
OWNER'SIgFI�MIT 5 '_ 1 00 -- -- — ------
AUTHORIZATION � TCT'AL FES � � �,�� x � RE �BuestEnENr FET
I HAVE THIS DATE CONTRACTED WITH THC HEREIN NAIMED CON- Ty ate,
TRACTOR 10 COI;NECr Tilt A[sCVF DESCR•BED EYISTING DWELLING APPROVALS _� D.;E' 1NSPECTOR'SSIC"NATURE�
TO THE PUBLIC SEWER
NEW HOUSE SEWER I -
SIG rED4!S- --_—:,,AY OF
CON'S LT ADDITIONAL
O!'v'NtR OR BUILDING OR WO.K
OWNERS LRS A C ti N:_. ___.._.-_ _ - _ -- - -- I
S+:PTrC rANK, SEER, PIT(S)
ADDRESS__
I HEkESY ACKNOWLEDGE THAT I NAVE READ TH-S APPLICATION CESSPOOL J DRYWELL Lel
AMID TL TRIAT THE ABOVE LS CORRECT AND AGREE TO COMPLY
WITH.ALL COUNTY f RDINANCES AND STATE LAWS REGULATING ALTER2 REPAIR. SEWER OR
PLUTA NG AND SEXERS 'CINACE DISPOSAL SYSTEM
' HEREBY CERTIFY TPAT ; AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REGUIRED BY LOS ANGELES COUNTY AND STALE OF
CALITORNIA OR THAT L AM T14E LEGAL OWIUER OF THE AeQVE ABANDGN HOUSE SE'E_P
DESCR,L','s6 RESIDENTIAL PROPERTY. '- -
� BACKFILL SEPTIC TANKS
SEEP.PIT(5) 0 -CESSPOOLS.-'.-CL �
SIGNATURE -
OF PERMITTEE ✓V 'p v��.f. �v �__
WILLIAM J.VOX, COUNTY r-NGINEER VALI ATION R,A.WOOD. CHIEF PLEG. INSPECTOR