HomeMy Public PortalAbout10414 OLIVE ST_Sewer__ S>a E-6E•6f39 72•$4 D APPLICATION FOR PERMIT A
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Department of County Engineer
County of Las Angeles BUDssG ' I
WM..J. FCX,COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT OF BUILULNG LOCALITY 'S-y✓'9s
FOR APPLICANT TO FILL IN fiEAREST
CROSS
LEGAL -DESCRIPTION____ LOT LOT NO, OWNER
BLOCK TRACT MAIL
j
ADDRESS
e r� NO. OF BLDGS,
SI- OF L0T ,��� '�.._.,E 3 t' NOW ON LOT - ,s C Y:' ✓,Ly - T.�'.` TEL. NO.
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`USE OF
BUILDINGS_ Z-1_ DISTRICT, ROOF AP
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CONTRACTOR
ADDRESS 1� r�� CONNECTION DATA
CITY""r' L. " STATION y - `�,+ r DEPTH
❑ S ATE ,.f :r,. s MANHOLE REFER>-NCE
REGISTRATION NO. ❑ COUNTY Sr r rte . , f1F°._,zip- __—u.___._�-•. IOW`F
TYPE OF C014NECT.ION t= NCTH FROM
NO. I DESCRIPTION OF WORK FEE Y. CURB P L. / M.L.TO P.L.
y HOUSE SEWER CONNECTING TO
I PUBLIC_SEWER _ (sty $ _3_.50 +-_ --
I HOUSE SEWER. CONNECTINGTO
PRIVATE DISPOSAL SYSTEM 1.00 -----. --- --CONNECT ADDITIONAL ADDITIONAL.BLDG. OR ---� _ - .
v { I ..I� Co. imp, NO - - •"'— ----____
WORK TO HOUSE SEWER —� 1.00 I � } s ;� _J06. N0,
ALTER OR REPAIR E.t dSTENG
SEaVER OR DISPOSAL SYSTEM 1 00 j I YRUNK PERMIT NO. ""— - ROAD PERMIT NO.
—_.-_ .Y.� __
DISCONNECTAND AB 0.N DON SEYr'ER {—
-- I -� STATE ENCROACHMENT
SPCSAL SYSTEM 1.0
AND/CR D _0_I_
SEPTIC TANK. SEEPAGE PiT OR f ---'- IER i11T NO_w_,
PITS AND/OR DRAINFIELD 2.0.0 i { INDUSTRIAL
I- V+A.STE APPROVAL —
CFSSPOOL-DRYWELL.__
_ SPECIAL CQNDITIONS ONLY 2.00CHARGES
V.d.{ _._ -- -- CONNECTION CHARGE FEE - -- ---
O'WNER'S �PERMT ___�$ i_�?-I �� _ _
AUTHORIZATION
T®IAL FEE ! t. . � b REINI$uRSE.M1fENT FEE
-I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CDN- APPROVALS DATE: � 1NSPEC70R'S SIGNA(I;RE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED T:y;s THIS-DAY OF`�..._�..___-_���t�_.__
OWNER ORCONNECT ADDITIONAL0'eY id ERS AGENT - -+^ - BUILDING OR WORK _
��s l SEPTiC TANK,SEEP, PIT(S)
ADDRSS -G��E �_.. -- ,AND/OR DF,AINFiELDT —
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W'ITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR -
PLUNIBiNG AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _RBAIVDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERjY. BACKFILL SEPTIC TANKS❑ 3
_SEEPPPIT(S) ❑ CESSPOOLS
-SIGNATURE - _
CF PERMITTEE
II I
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
By 2 Sit Q 2 u, APR 2 5 4 4.5 �? �
DEPUTY DEPUTY
BY BY CF4
DEPUTY DEPUTY