HomeMy Public PortalAbout10232 OLIVE ST_Sewer__ i
CE808 10.82
.dA 842(J.
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL_ 1!
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FLD
10FLN A. LAMBIE, Counter Engineer
WILLIAM A. JENSEN, Supt of Building EAREST
ICOR APPLICANT TO FILL IN
EGA._ fes'%
DESCRIPTION oT Na OWNER
FLOCK TRACT ADDRESS
NO. OF SLDGS.
SIEE O" LOT
NOW OI`i LOT' CITY TEL- NO.
11.5E OF
BU!LCINCS DISTRICT NO. GROUP MAP PROCESSED BY
CO.NTRACrO'fii_ r �` ,✓ - 1 ,'� �"' `r+
ADDRESS ` ' .f ` ,.,. CONI ECTION DATA
S7A7iON DEPTH
Fd
CITY � '.�TEL N0. -
i .. ..-STATE
MAI`dH0_t.Rt F'EREM1 CE;
PREGISTRATION NO. � i -. � "j' C� COUNTY L� � LOWER
NO. l )DESCRIPTION OF ORK_--f FEE TYPE OF CONNECTION LENGTH FROM
HOUCSEW ER CONNECTING TO l Y.
SCURB Y L.'' M.L.I'D Y.L.
--- PUBLICS]WER '@ $ 'oo P.C.N6.
SEFT IC.-.AN-_.SEEPAGE FLIT OR I
PITS AND
OR ORA?Fdr'E-LD � i Ocz ! ' _CO. IMP' NO. JOB NO.
O. --— -..— --------- -- — ------
!
HOUSE SEWER CONN .TING TO TRUNK PERMIT NO. ROAD PERMIT MO.
PRIVATE DISPOSAL SYSTEM
_.._. _._ _.._-
I C OIyNEGT ADDITIONAL.BLDG OR . � AFFIDAVI � W.a!i 2 lhSEMEk'T � RECORD.INSTR N3. T-J--DATE LU
TO HO SE SEWER � $3.Oq _ I
OV RFLO H SEEPAGE PIT,DRAINFIFLC
EXrN eCE SPOOL,DRYWELL,MANHOLE $-..:QO Z
HWYOR 5T.W7DEN',NG
.
A TER REPAIR OR ABANDON HOUSE
5 Wi=•f'c OR Di5f'OS QL SYSTEM ,p 3..00 STATE ACH
Elkli t.1.ENT
- - - PERMIT NO.
i
INDUS'YRiAL
I WASTE APPROVAL
CHARGES
O L P EMIT � z a0 -- -- ---- - _ --- .---
--
—. CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE "
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RFEMBUR�qSyEMENTttFEE
r��e
TRACTOR T() .:O NEC'T' THE ABOVE DESCRIBED s•XIS7i Mt; OW£Ll._I1`dG ACY'I�®YAInJ -- --
TO 7hE PUSi_k SEWER, DATE - IN PECTOR S SIC-NATURE
SIGNED 'THIS __T,.E-AY
OWNER.OR .` �' --�` NEW HOUSE SEWER
OWNERS AGENT" CONNECT ADDITIONAL
ORK
.J �,FkEBY ACKN
BUILDING QRS SEEP,
ADFtS
-- SEPTIC TANK,SY -,PIT(S)
I ..EDGE rHA I HAVE READ 71 APPLICATION AND]Oft DRAI.NPIELD
AND STATF THAT'I HE A19ri'VF: IS CORRECT AND AGREE TO COMPLY
WITH AL COUNTYORDINANCES AND STATE LAWS REG_IOATING
'
PLUM[31Nf AND SEWERE. CE'-SPOOL
ORYWELL U
I HEREBY CFR"IFY THAT i .AM PROPERLY RF_G(S ERGO AND/OR ALTER.REPAIR, EWER
L.iCINSED AS REQUIRED 13Y LOS ANGLES COUNTY .AND STATE OF SEWAGE DISPOSAL SYSTEM ! 4
:CALi 'ORNIA O� THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND -�_--�---- --_- ------------
AFSiDe IN, -THE ABOVE DES RNBED RESIDENTIAL FOPERTY.
-9 ABANDON HOUSE SEWER
SIGNATURE -
'' / / fSAKFILL EPTIC S'
NR
0{= PERMITT E
SEEP,P!T(.S) C€..SPOOL'.$
' -VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. �' 11.0 CASH
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