HomeMy Public PortalAbout10405 OLIVE ST_Sewer__ 7GA6421?
E-C63 11-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY -SEWER—SEWAGE D ISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER -AD—DR-E—ss io4O5 Olive—S-treet
D CASSATT D.GRIFFIN, SUP'l OF BUILDING LOCALITY r.1
zemple ,,City
NEAREST
FOR APPLICANT TO FILL IN _CRQS5 5T.
LEGAL
DESCRIPTION LOT`No� OWNER Selected Homes
BLOCK TRACT ZftEss 829 San Gabriel
N BLDG CITY Sari Gabriel TEL, NO.
SIZE OF LOT NOW ON LOT
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USE OF
BUILDINGS DISTRICT NO. GROUP- MAP
BK PG
CONTRACTOR _ya CC-1-p1r�,
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ADDRESS 1q4617 IE. Rarmona Blvd,. CON CTION DATACITY Badwin ParkTEL. No. ED-81127 STATION DEPTH---
MANHOLE REFERENCE UPPER
STATE Ek
7
1 --I I
STATE
'0,
REGISTRATION NO, 197747 0 COUNTY
NO DESCRIPTION OF WORK FEE
-- ----- TYPEF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO CURB P.L. M.L. TO P,L.
PUBLIC SEWER @ $3�50
-TSE-P-TIC,TANK,SEEPAGE PIT OR
PITS AND/02 DRAiNFIELD
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C, NO.
DO
EXTN.,CESS POOL,DR YWE LL,MANHO LE $Z,i 1 CO. IMP. NO' JOB NO.
HOUSE SEWER CONNECTING TO
—1-PRIVATE DISPOSAL SYSTEM ca $1,00 TRUNK PERMIT NO. RQ71D PE
RA IT NO, X
77-
CON R T ADDITIONAL B 2,�
-LQQ_ STATE ENCROACHMENT
RK TO HOUSZ-SEWS-R $F.00 PERMIT 7-7=7— v- ell
N.O.
1\, A ER.RCF:ZR OR ABANDON HOUSE "�
iTSGUSTRIAL
SEWR OR DISPOSAL SYSTEM ((v D c,
WASTE APPROVAL
CHARGES
CON14ECTION CHARGE FEE
OWNER'S PERMIT
REIMBURSEMENT FEE
AUTH04MZATION TOTAL FE
1 0;
E AT THIS DATE A CONTRACT WITH THE. APPROVALS
HERFIN NAMED CON- DATE INSPECTOR'S SIGNATURE
I HAVE.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DV7ELLING
TO THE PUBLIC SEWER. '
NEW HOUSE SEWER
SIGNED TH!S---DAY OF----19
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
z
OWNERS AGENT--------- SEPTIC TANK,SEEP,PIT(5)
ADDRE AND/OR DRAINFIELD
I HEREBY ACKNOWLZI)GE THAT " HAVE READ THIS APPLICATION CESSPOOLLJ DRi INELL. 1
AND STATE THA THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SrVIiERS. SEWAGE DISPOSAL SYSTEM
I ii".REEY CERTIFY TH,T
I AM PROPERLY REGISTERED AND/OR D
ISCONNECT PULIG AND
LICENSE
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CAUVORNIA OR THAT I Am THE LEGAL OWNE�OF, THE ABOVE
DESCRIBED RESIDENTI_,kL-+LyOPL k3ACKF ILL SEPTIC TANKS
SIGNATURESEEP, PIT(s) L; crsspooLs 0
OF PERMITT,
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT'A,WOOD, Ci-IIEF PLBG. INSPECTOR
CK. M. Q, GASH
J