HomeMy Public PortalAbout10415 OLIVE ST_Sewer__ g°
s E•�63 3.3*3 APPLICATION FOR PERMIT 7q
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DIVISION}' OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer _
County of Taos Angeles BUILDING `' , _ '
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT A.GRIFFIN,SUP°T OF BIIILDINO LOCALITY
NEAREST
--�-'
FOR PILI IN CROSS ST. �
LEGAL �'3'"
DESCRIP I N'�Yr:�).Ffr O,. .... '•� OWNER 'S
BL 3 cry_ f e,! MAIL
—.� ADDRESS___
NO. OF BLDGS.
SiK OF 1.07 NOW ON LOT CITY TEL. N0.
USE OF
BUILDINGS �' „y' `" DiSTRSCT N0. i GROUP MAP
PG
CONTRACTOR
ADDRESS ;; y; ,r'' zv CONNECTION DATA
CITY ? �.� TEL. N0. STATION < DEPTH 9
y„ .. ❑ STATE
MANHOLE REFERENCE r ., _ UPPER`
REGISTRATION NO. .� ' :� 'L° '' .,� ❑ COUNTY � -
r
NQ. I DESCRIPTION OF wax FEE_ __
HOUSE SEWER CO..... NG TO -~ �. Y TYPE OF CONNECTI -�?,., LENGTH FROM �y
J PUBLIC SEWER 02 $ ?.50 CUPS--- r P L.. _ M.L. TO P..L_
—I HOUSE SEWER CONNECTING TO --� --'— '--- --_^ ---
+ PRIVATE DISPOSAL SYSTEM 1 0_0 r _
:I � ORK 3q -3CU5CONNECT ADDITIONAL BLDG. OR —� P C. N0. -
_ SEWER4 --_ CO, [h1P NO. JNO.
_E i_.00 If - - --. _QB _
ALTER OR REPAIR EXISTING —+
cNER OR DISPOSAL SYSTEM 1.00( TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT N!CT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEI4i 1.00 I�
PERMIT NO.
—�
SEPTIC TANS. SELPA £ PIT OR I
PATS AND/OR DRAIN IELD 130 INDUSTRIAL
CEo.^�P00L- DRYW£LL ` `" WASTE APPROVAL
��. SPECIAL CONDITIONS:ONLY 2.00 CHARGES !
CONNECTION CHARGE FEE
OWNEWS PERMIT ��� t 00 -- - -- —
AUYFIGI3I ATION �TOTAL FEF i 4d/ rely REIMBURSEMENT FEE
"._.
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NA4IED CON- Ps ss �v
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE I!tSPECTORS SIGNATURE i
-TO THE PUBLIC SEWER - ��..---
NEW HOUSE SEWER 1 -
SIGNED THIS -DAY aOR I_
CONNECT ADDITIONALOWNER -
OWNERS AGENT ' r6 '"`�'�• _BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS_ _—r__-�. .-_----- -..- -_l--- _AND/OR.DRAINFiELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ C1_ I
DRYWELL
AND SATE THA? THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR SEWER OR
PLUMB NG.AND SEWERS. _ SEWAGE DISPOSAL 5`!5_EM i -
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 RESIDENTIAL PR PERTY. BACKFILL SEPTIC TANKS❑—v
9 ,(,,�/ SEEP. PIT(S) ❑CESSPOOLS❑ _
SIGNATURE r
OF PERMITTEE
WILLIAM J.FOM: COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLEG. INSPECTOR