HomeMy Public PortalAbout10243 OLIVE ST_Sewer__ :yBQA 90-6.2 Ly!
6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL..
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION TN
i_DI NG
JOHN A. LAMBIE, County Engineer RESS
WILLIAM A. JENSEN, Sug't of Building
ALITY
RESTFOR APPLICANT TO FILL IN
SS ST. �. s
DESCRIP LOT Nc_ !'1 j OW N'ER
MAIL
J
BLOCK TRACT ADDRESSd NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO,
USE OF
BUILDINGS D:STRI.C'r NO. GROUP MAP PROCESSED BY
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JJ CON ECTION ATA _
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CITY . TEL NO. Arc,.: t.' S'i ATION ,C-.. ...< ' x :. QEPTH
UPPER
REGISTRAV ON M1C b STATE MANHOLE REFERENCE / "5
COJA3TY
NO-1 DESCRIPTION OF 'WORK FEELENGTH F OM
HOUSE SEWER CONNECr1NG p Y- CURB >p> _._ M.L TO P - ,
PLB IC SE JdER
a !'SEPTIC TA Ivn .55EPACrE PIF OR I , e� P.C.NO. �
PIT$ANIO10R DRAINFIELD (9 $]0.00 I CO. IMP N:7. JO_B NO.
HOUSE 5fW ER CONNECTING TO�--- --- ---r_
-` TRUNK PERMIT NO. ROAD PERMIT NO.
PR.IVA.TE DISPOS AL SYSTEM @ $300
CONNECT ADDITIONAL BLDG OR.LL- �--��—�- AP FIDAV17l YJAIIII T EASEMENT? RECORD. INS7R NO. DATE_----_ I
--tl WORK TO HOUSE SEWER @ .$3.00
I OV RFLOW SE PAGE PIT,QRA N.FIELD
--�FXTN,.CESSPOOL.L)RYWELL.MANHO_E $5.00_- HWY. OR ST.WIDENING
a.
ALTER.REPAIR OR ABANDON HOUSE
CWER OR D.SPOSAL SYSTEM $3.00... '
---- --- - --- - -.----- - STATE ENCROACHMENT
I 7.� P_RMIY NO.
------ INDUSTRIAL
WASTE APPROVAL
CHARGES
C»NER'S PERMIT --- $==,-- ' 00 _ ------ ------ -------------
AUTHORIZATION TOTAL FEE /17 CONNECTION CHARGE FEEI kV
'I HAVE AT THIS SPATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBUR5EMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED ELISTING DWELL,NG ----- n -/q—g 7--�-v- ----
TO THE PUBLIC SEWS j /: APPRO1iAL5 DATE INSPECTOR'S SIGNATURE
SIGNED THIS i.]A,y-OF -��.' 19 'I —'-- --- ----- --
OWNER OR 4` 1 NEWHOUSE SE'AER.___._ _
OWNERS AGENY F ✓ J-��_ CONNECT ADDITIONAL
BUILDING OR WORTS.
SEPTiC
TAN!( SEEP P17(5)
' NFREHV ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONANDNO/O�OR DRAINFIELD I
AND STA tE THAT THE AEiOVE IS CORRECT AND AGREE TO COMPLY
W'ITH ALL COi'INTY ORDINANCES AND STATE LAWS REGULATING r '
FLl+MBING AND SEWERS. GESSPO.OL 0DRYWELL L1 I
i ,HEREBY C UT.FY:, THAT i AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR j
LICENSED AS R Q:,IRED 1' LO,9' ANLsLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THiT Lf Lt"
L,C ME OF', AND INTEND T6 DISCONNECT Ei PLUG AND
_�- --- _----- ---
RE51 DE N, TH A3PVE DS5 :EE3 FyL+'SI ENTIAL FROR ERTY.
d d DON COPSE G D
SIGAdATU RE x_,
Of' PERM{TY �.f _ / -__ __�-_-_- BAC KF.LL t
1'" E„a. v- P a CE:5SPOOLS
VALIDATION— ROBERT A. WOOD
SUPERVISING MECHANICAL. ENGINE=ER
,�K. M.0 CAS>t