HomeMy Public PortalAbout10411 OLIVE ST_Sewer__ ,SA3
E-6$a sl•ss APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer.
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS "
P7 CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS Sr. �
LEGAL pl ;
DESCRIPTION LOT NO 1�' �✓ y' �� `....- . �- OWNER T j„ D% i ' 9, agF'n-° LwMAIL
1S
BLOCK TRACT _ ADDRESS ' 'x u k tai."
N0. OF BLDGS.
_SIZE OF LOT -�-"----- - _NOW ON LO1'_..--- -.� CITY .+'�=' 'old � � --Q,,: TEL.NO. ,/1'
USE OF - r
BUILDINGS DISTRICT NO. I GROUP MAP
BK PG
CONTRACTOR
CONNECTION DATA
ADDRESS - ------ - -------�._� —.--.._
. - STATION :dY' :.��.� DEPTH
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CITY TEL.. NO. .�. _
MANHOLE REFERENCE +
{] STATE
REGISTRATION NO. �'j COUNTY
NO DESCRIPTION OF WORK FE-- - _ x - ° ✓ I- - —
HOUSC SENdER CONNEC7INGTO- TYPF. n "COLENGTH FRO
I
PUBLIC SEWER _ �� _$3.5J I -Y' -.-" CURB
B _-_P.L. M.L.TO A.L. .___..
--SEPTIC TANK,SEEPAGE P17 OR----- _.
PITS AND/OR DRAINFIELD 0c� $3.00 I
. 0ERFLOW SEEPAGE PIT,DRAINFIELD ----I- - P C. N0.
EXIN.,CESSPOOL,DRYWLL,MAN HCH LE la $2.001
CO. IMP. N0.
HOUSE SEWER CONNECTING TO j � -
_ j PRIVATE DISPOSAL SYSTEM (t1- $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
CONNECI`ADDIT IGNAL BLDG.OR. STATE ENCROACHMENT
_- WORK TO HOUSE SEWER "ca! $1..00 i. PERMIT NO. _
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM _ -_- U $1.00 WASTE APPROVAL "-------------- -�-
-t ---- - --- ---" - -- i- —- -
I -- .CHARGES
CONNECTION CHARGE FEE
O'WNER'S PERMIT _ 5 �- 1!f _00 REIMBURSEMENT FEE
-----
AUTIIORIZATION TOTAL FEE 4
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS
DATE iINSPECTOR'SSIGNATURE
TRACTOR TO C014NECT THE .ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THIS "�'
�p DAY O n CONNECT ADDITIONAL
-F
OWNER OR s3`�'r y *' BUILDING OR WORK j
OWNERS AGENT ✓ °✓F- �- � 1� :�'£. � SEPTIC TANK,{k-,SEEP._. ._!T(S)
R
AND/OR DRAINFiELD
ADDRESS—i,'f` 3 SG Lle, '`"rt'- '.aAt' t,«.�Lk,xC„'trd __...__.�
I HERESY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION• r_ESSPOOL❑ DPYtL`ELL I.� 91
AND STATE THAT THE ABOVE..IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR I
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT 1 ,'!M PROPERLY RES-}STEREO AND/OR I�_�___.—__..
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT14L PROPERTY, BACKrIt SEPTIC TANKS 0
SIGNATURE �_ SEEP PIT(S Ll CESSPOOLS❑
OF PERMITTEE
-- ' .',L - -- —" -- — -I-----
JOHN A. LAMBI'E, CCAJ.NTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CASH -