HomeMy Public PortalAbout10322 OLIVE ST_Sewer__ :E80810-63
6A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN. Sup't of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL LOT NO, 4 E
OWNER
,RIP,:ON DES(
MAIL
BLOCK TRACT ff. <-� '5
ADDRESS
NO. OF OLDGS,
SIZE OF LOT NOW ON LOT
TEL. NO,
T N U MAP
WSTRIC 'to Q.0 E s S-F-P BY
4• G
BUIL INGS
PG
;iA
CONTRACTOR
L
ADDRESS X rnmVrrTTnN DATA
STATION DEPTH
CITY TFL�.__NO_
STAT UPPER
COUNTY co-INE-R—
REGiSTRATICIN NO. MANHOLE REFERENCE
7,-/
OF T FROM
WO..K FEE _TVPi CO ECTFON LiNG H
R CO Y. CURB I-.L. M.Ll.TO P.L.
SEWERFUB Ir. P.C.NO. ,
OU BE.5
, S_E ,A
E I-� I N i
'T JOB NO.
'I, DR IN, 0�00 CO IMP,NO�
AN, OR A
HOUSE
SEWER CONN
0NWZ TRUNK PERM I VNO. ROAD PERMIT NO,
I PRIVATE DISPOSAL SYSTEM @ $3.00 LX
AFFIP�yl AIVER EASEMENT RFII-,ORD.zNSTR.NO,
ADDiTIONAL BLDG.0*� i DATE 0
I �HOjSE SEWER $3.00 1.-
jlti—? 1'1�,04'
W SFEPAGF.-IT,DRAiNFIELD
OVERFL
FX-rN..CfF.SSPOOL,DRYWEL,L,MANHOL.F @ $5 DO
HWY. OR ST.WIDENING
ALTER.REPATR ABANETbh HOUSE i V)
SEWER OR DISP SAL SYSTEM @._$:3_0 -----1.__--____ STATE ROAC E
_ FINCI
- WENT
H
PERMIT NO.
INDUSTRIA'
WASTE APPROVAL
OWNER'S P RMIT 2� 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE If/-I`, __ — - ___
HAVE AT THIS DArF A CONTRACT WITH THE HEREIN NAMED CON- RF!MBURSEMENT FEE
TRACTOR
R ACTOR To Cf�''.qNEc,,r THY ABOVE DESCRIBED EXISTING DWELLING
To THE P VQLiC SEWER. DATE 1INSPECTORS S;GNATRE
SIGNED THIS
OWNER OR NEW HOUSE SEWER t
_W C
NERS AC;ENT
CONNECT ADDITIONAL
BUILDING OR WORK
T
SEPTIC TANK,SEEP,P;7(S)
HERESY ACKNOWLEDGE THAT I HAVE REAL) THIS APPLICATION AND/OR DRAIN F]F"D
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -_j F
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
P"_U MM INC, AND SEWERS. CESSPOOL DR WELL
I HEREBY
-By "ER"I"Y' TH Al I AM. PROPERLY',REGATERED AND/OR ALTER,REPAI R SEWER OR
"'C'NSED AS REQUI Los ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM.
CA.I
ORNIA OR TH#_'__! AM THE LEGAL OWNER CIF, AND INTEND 'TT)%P5
.-�F CONNFCT PLUG AND
PE 0 E IN, 7-U. A6JPVF. DESCRIBED RESfr.)Ej�T),�V PROI�.IiEIVTY. APANDON HOUSE SEWER
BACKFILL SE_PTIC TANKS F__j
__z�_X
S!GNAT I,,RE,
PERM! If
I
SEEP.PIT S) CESSPOOLS ;�
(ItAdDAMN ROBERT A. WOOD
CK_ M.O. CASH SUPERVISING TAECHAWCAL ENGINEER