HomeMy Public PortalAbout10409 OLIVE ST_Sewer__ APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I SPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING -fir
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF SUILDING LOCALITY
NEAREST
—-- FOR APPLICANT TO FILL IN cRoss.ST. '`
LEGAL'
DESCRIPTION— LOT NO `�_` ,�" j.,,� tom- OWNER }. %. ,>�`p. A v a t 4 j�, . e')
MAIL
SS .
BLOCK TRACT ADDREa °
N0,OF BLDGS. y r o.
SIZE OF LOT NOW ON LOT CITY -',4- Cd {'., 3"t ; TEL. NO.
USE OF MAP DISTRICT NO. GROUP 1
BUILDINGS I BK PG
CONTRACTOR
ADDRESS _ CONNECTION DATA
DEPTH
CITY- --._-_.-`--_- ._ TEL N0--f---^ ------- -.---- MANHOLE RE' FERE`NNCCE
� STATE ''' !���� :'d� e>' .".
RECISTRA'IION NO [] .COUNTY r° v -�` "
NO. DESCRIPTION OF WORK FEE — =;
iOUSE SEWER CGNNFCTING TO - TY�Od'CONNECTION LENGTH FROM
PUBLIC SEWER Y'---- CURB P.L. M.L.TO P.L.
j-SEP?1C T/;NK SEEPA�.E
P17S AND/OR DRAINFIELD __ __ C. $-
OVERFLOW SEEPAGE PIT,DRAINFIELD P C. NO. ✓ ",/ s
EXTN.,CESSPOOL.DRYWELL,MANHOLE q' $Z.DO CO. IMP. N0.
HOUSE SEWER CONNECTING TO —'- -- ~
PRIVATE DISPOSAL SYSTEM (�. $1.001- TRUNK PERMIT N0. RMIT NO
CONNECT ADDITIONAL BLDG.OR I— - STATE ENCROACHMENT
WORK TO HOUSE SEWER _ _ _ ( $1.00 PERMIT NO.
T� ALTER,REPP.IR OR ABANDON HOUSE - ---- --- ------ — - --- -----_--
SEWER OR DISPOSAL SYSTEM ( t.00INDUS'T'RIAL ^
---— $ ..�_ WASTE APPROVA
-I- - ---- -- -._-. CHARGES '
CONNECTION CHARGE FEE
OWNER'S -PERMIT _ � _ 1 00 --
--- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE ^ �
TRACTOR tq CONNECT THE ABOVE DESCRIBED EXISTING
NA ED CON- APPROVALS DATE (INSPECTOR'S SIGNATURE
E - sDWELLING ----- - -------- --I—-----! — --- —.-_
I HAVE AT THIS DATE A CONTRACT WITH THE Ht !{
- ' iSfING �
TO THE PUBLIC SEWER, _ --- - NEW HOUSE SEWER {.
__ -D
SIGNED THIS DAY Or > X19 a � cDNNEc ADDtr,GNAL
OWNER OR I r BUILDING OR WORK
OWNERS AGEN '`�� .,`��-< - SEPTIC rKNK,SEEP.PIT(S)
7.
AD-DRESS . ANb.(GR Dh.1i'vi`I[LD __ - ----�-------- -----
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESS POOL['.1 DR WELL' --�
AND STATE THAT THE ABOVE IS CORRECT AND ACREw 70 COMPLX
WITH ALL COUNTY ORDINANCES AND STATE LA"+5 REGULATING, ALTER,REPAIR,SEWER OR.
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _ +_
HEREBY CERTIFY 114AT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG.AND
AS REQUIRED BY LOS ANGELES COUNTY ANP. STATE OF
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRi3ED RESIDENTIAL PROPERTY. _ BACKFILL SEPTIC TANKS(_J j
- c - - I ISEEP. P17 S1 ----- —
SIGNATURE ..,, 1. L
OF PERMITTEE x ° -
I
IOHN A, LAMBIE, COUNTY ENGINEER VALIDATION.-_-w, ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N.0. �°CASH