HomeMy Public PortalAbout10413 OLIVE ST_Sewer__ &E-6-6£iD5 3->E APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL. d
Department of County Engineer
County of Loa Angeles 2UILDING p -
WM.J.FOX.COUNTY ENGINEER ADDRESS v J tr
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR AFPLICANTT TO FILL IN NEAREST
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LEGA -1Y - - 3r' �a �
DESCRIHT�tI LOT'iY0 .' '� ;.' ,,.id.��..,. a'-`J .$ OWNER
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MAIL -
---.-- �*� ADDRESS
,SIZE OF LOT NO. BLT
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NOW ON LOOT CITY TEL. N0.
USE OF
BUILDINGS µ DISTRICT NO.. GROUP MAP- "
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'_GROUP
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CONTRACTOR ! f �: -''� .��.- i � - ✓'" - 4�.3' ,J',.."'; ;-..
+ADDRESS t; " .-= r. .: CONNECTION DATA
CITY a TEL, NO ,--s •� ts � � , _STATON DEPTH
G STATE MANHOLE REFERENCE �r ^ UPPER-
R€GISTRATION NO. -f '- �"'�� "�f ,J ❑ COUNTY -•------ -- -+ - R�
No. DESCRIPTION OF WORK FEE
--� HOUSE SLhER CONhECTIPG TO
Ca•. $ 3.50--- --' — TYPE OF CONNECTIO0P�^e LENGTH ROM, r
{ rl !- Y` CU�T3 , L,"j rf L. IO l 6
PU3LIC SFW ER I `(. -
HOUSE SEWER CONNECTING TO -^ --� ----� —
PRIVATE DISPOSAL SYSTEM] I.00 ---- ---_---
-. _
CONNECT ADC;TIONAL BLDG. OR P. C. NO
vd0it! TO -HOUSESEWER__ 1.00_ I CO._,P rdn, _ 03 NO.
A 7CR OR REPAIR EXI:'iNG
S WEE OR DISPOSAL SYSTEM_ 1.00 "TRUN; PERMIT NO. ROAD PERMIT NO,
4 DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
D'+.SPOSA_L SYST Mi 1.00 PERid1T Np._
SEPTIC TANK, SEEPAGE PIT OR
CESPOOL DRYWELL fINDUSTRIAL
PITS AND/CR DRAINFiELD .001 WASTE APPROVAL
S
--_SPECIAL CONDITIONS ONLY 2.00 CHARGES
i
CONNECTION CHARGE FEE
OwNEII'S PERMIT 5I i 00
AUTHORIZATION TOTAL FEE ✓ r REIMBURSEMENT FFF
I HAVE ' HIS DATECON-
TRACT�ORTTo CONNECT THEACTED ABOVEWITH DESCRIBEDTHEHEREX STINGAMED DWELLII G APPROVALS DATE I NSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER - - - -- •..� -----.—�— ---- —
NEW HOUSE SEWER
SIGNED THlS- DAY OF 19.�.
OWNER OR :i CONNECT ADDITIONAL
OWNERS AGENT "yi�.'.�' '' BUILDING OR WORK_
SEPTIC TANK,SEEP, PIT(S)
AND/
F,ODRESS _ AND/OR DRAINFIF.LD _
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL_❑ DRYWELL`[I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR �T
PLUM.B:VG AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR —'---""-----"— - -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. - _._.L.—..__
BACKFILL SEPTICCTANKS C',
SIGNATURE SEEP•PIT(S) 0 CESSPOOLS-❑ _
OF PERMiTTEE 1
WILLIAM J.FOL`-COUNTY ENGINEER VALIl3ATION R.A.WOOD, CHIEF PLEG. INSPECTOR