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HomeMy Public PortalAbout10325 OLIVE ST_Sewer__ 76A642D 64 APPLICATION FOR PERMIT" s,%! COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING � JOHN A. LAMBIE, County Engineer ADDRESS 7 z f L' WILLIAM A. JENSEN, Supt o4 Building LOCALITY NEAREST FOR APPLICANT TO PILL IN CROSS 5T. �: '� 'yl p1 °/ LEGAL t DESCRIPTION ,LOT NO. OWNER ,/ } MAIL BLOCK`— TRACT : a. C +� X,, '`_"` ADDRESS 1611 Ily NO. OF SLDGS. SIZE OF LOT NOW ON LOT _ CITY TEL. NO, USE OF BUILDINGS [:'Lf,,r �-.L-�Ic('.'�,s�„ DISTRICT NO. GROUP MAP PO PROCESSED BY CONTRACTOR i CN 4/ .. ,�^• ! �dj'�� �,,. 3M j a E. a.� y �f'� -..- �t ryl ,h' f �/ .+t ('� ADDRESS % �"_ /_-� CyONNECTION DATA t STATION - J ,y... CITY n ♦ � `kZ° I�L-TEL. NO. DEPTH� T L.-' "�� � � ''' j - "'b` ATE MANHOLE REFERENCE &y f fig/ REGISTRATION NO, ,/ ,C / --� COUNTY ':. r !i y'1 �, LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONN.ECTIOF(� / LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P L. M.L.TO P.L. - -I PUBLIC SEWER _ $3.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR - .I PITS AND/OR DRAINFIELD 5!_0_.00 �I CO.IMP. NO, / �1 JOB NO, a. HOUSE SEWER CONNECTING TO 1 TRUNK PERMIT NO. ROAD PERMIT NO, 1 I PRIVATE DISPOSAL SYSTEM (9 $3,00 CONNECT ADDITIONAL.[`p ,s AFFIDAVIT wA1vSS SAS[MSNT RECORD, INSTR.NO, DATE w WORKTO HOUSE SEWER 6 $3.00 � �"��` O I OVERFLOW SEEPAGE PIT.ORA-INFIELD-----T--� EXTN„CESSPOOL,DRYWELL,MANHOLE ALTER,REPAIR OR ABANDON HOUSE HWY,OR ST.WIDENING Q- __ �. SEWER OR DISPOSAL- SYSTEM ;3.00 STATE ENCROACHMENT N PERMIT NO, z ' INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT �$ ��21 0 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE — '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RE IMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEVfFL, ie� _ APPROVALS DATE INSPECTORS SIGNATURE SIGNED THISAYOF .� 1,r- 19 ,_:. -- - --- -._.. OWNER OR % -a NEW HOUSE SEWER OWNERS AG�NT, � "`a CONNECT ADDITIONAL ! BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT{S) LL AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY _— — WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND i RESIDE IN, THE ASOY(E DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMI7TEF -- -(: C -Y �' �`` �' -ti-- ©ACKFILL SEPTIC TANKS ❑ -r ❑ CESSPOOLS [A 1 VALIDATION. ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.0. CASH ff++ L #Cr +3 C3 'jai L L D 4�.4J N,