HomeMy Public PortalAbout10413 1/2 OLIVE ST_Sewer__ 76A640p
s.eea�•es APPLICATION. FOR PERMIT`
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DIVISION OF BUILDING AND SAFETY SEWER,--SEWAGE DISPOSAL
Department of County Engineer _
County of Los Angelesa�ass� � 1> r�
WM.J. FOX, COUNTY ENGINEER —
CASSATT'D.GRIFFIN, SUPT OF BUILDING LOCALITY
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CONTRACTOR '"i�,'y,a. :- -�� - ,r-�.:i-l'"f..�% I _.._... i .. .J;.:
ADDRESS _ CONNECTION DATA _
CITY _ y ... TEL. NO.4G 8Y' = ie`%' _STATION -- �i 3 DEPTH
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REGISTRATION NO. �' �� , �' I„] COUNTY
No,t DE CRiPT1(7N OF WORK FEE
--i - --- YiTYPE OF CONNECTILENGTH FROM
f MOUSE 5 VER CONINECONG TO �-,.
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PUCLI SEWER (2 a� 3.Krj_ Y. CURB 'L ni L. 7"0 P.L. -w
—( HOUSE SEWER CONNEC74N6 T0.—'_ ..� .
_J PRIVATE DI*POSAL SYSTEM 1.00 -- ------- ---
I
COINNECT ADDITIONAL BLDG. OR - --- CO. Itd Y. NO.
POB NO .
WORK TO HOUSE SEWER 1.00 _ -. _ —.
ALTER OR REPAIR EXISTING
SCINER OR DISPOSAL SYSTEM I.,DU ---_ TRUNK PERMIT NO, ROAD PERMIT NO.
�I DISCONNECT AND ABANDON SEWER — � STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM__ 1.00 _—� PERMIT NO.SEPTIC TANK SEEPAGE PIT OR -. -.._ ------_----------.
PITS AND/OR DR_A_INFIEL_D GO INDUSTRIAL
1 CESSPOOL-DRYWELL — WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.OiOy CHARGES
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CONNECTION CHARGE FEE �
OWNER S --
PERMIT $ 1 00 --- -- ----_— _ __
�__ � ._�
AUTHORIZATION TOTAL FEE � ,i' `���� REIMBURSEMENT FEE
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1 HAVE THIS DATE CONTRACTED WITH THE HEREIN
_NT TD �s +��� --
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE�..
TO THE PUBLIC SEWER �®`�f
SIGNED 1HIS_.�__v'AY GY—.v 19-- NEW HOUSE SEWER —W T-
OWNER OR CONNECT ADDITIONAL --
OWNERS AGENT BUILDiNG-OR WORK__—__
SEPTIC TANK, SEEP. PiT(S)
AND/OR DRAINFIELD
�i HEPERY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL 0
AND SATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR.
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM 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 ABOVE ABANDON HOUSE SEWER
DESCRIBED tRESIDENT1Ay `2,ROPE$TY, BACKFILL SEPTIC TANKS 0
ff y SEEP.PITS) [] CESSPOOLS
SIGNATURE
OF PERh4iTTEE
WILLIAM J.FOX.COUNTY ENGINEER V1gI. ATION R.A.WOOD,CHIEF PLEG. INSPECTOR
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