HomeMy Public PortalAbout10508-10512 OLIVE ST_Sewer__ i&E-6 319.5., APPLICATION FOR PERMIT/,0
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. 1_ANIBIE, COUNTY ENGINEER ADDRESS
:7 CASSATT D. GRIFFIN, SU>"T OF EUILDING LOCALITY ...f:....._::.• /r, { / ';/
FOR APPLICANT TO FILL IN NEAREST
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MAIL
BLOCK_ j
'TRACT a, ADDRESS --
- NO. OF BLDGS. j` CITY TEL. NO.
-SLZE OF LOT^ ! ./. NOW ON LOT _:.
USE OF DISTRICT NO. GROUP MAP
BtiILD(NGS -- i
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CONTRACTOR
CONNECTION DATA – — -
ADDRESS d'• rp .j �✓� j`3'" (• 'jr ----- -_..._.. __ ---...--- - — ------
3 -- STATION ., `- DEPTH
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4/ TEL.NO. � 7
n 1- MANHOLE REFERENCE - - LPPEFt.-.
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REGISTRATION NO. --- ,. ` COUNTY
No j DE5Crt�P71ON OF WORK rEF TO —
94V ER.CONNErIN+s —1 OF CONNECTION LE14GTH FROM.
r'CUSE -
-� -- _� Y CURB r P ' � M L O? P L
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PUBLIC L I C SEW" -
F
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 0e $3.00 j _ ----------------------- -------------.
----------.-- .- --- ---- P. C. NO.
i OVERFLOW SEEPAGE PIT,DRAINNELD ��--
-� LxiN.,Ci,SSPOOL,DRYWELL.MtAN}iOLE L) °;2.OQ' 1 CO. IMP NO. JOB NO.
_.
F. ._ —_
HOUSE SEWER CONNECTING To �
r PRIVATE DISPOSAL SYSTEM:: (c 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
.' CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
M
WORK TO HOUSE 5F.A1FR _ _ �a $1.00 :> :_' FERMIT NO-
ALTER,REPAIR OR ABANDON HOUSE rT
INUU57ft1AL -...-
EWER OR DISPOSAL SIS'FEM c I.C!0L 1,rA.5TE APPROVAL -
------ - CONNECTION CHARGE FEE .-
OWNER'SPERMIT S Y OC F'EtMBURSEutENT FEE
AUTHORIZATION TOTAL FEE
I H.[IVE AT THIS DATE.' CONTRACT WITH THE HEREIN NAMED CON APPROVALS i DATE INSPECTOR'SSICN.A7 UP_
TPACTOR TO CONNECT THE ABO'VE DESCRIBED „X.IS7ING DWELLING -----
TO THE PUBLIC SEWER.. NEW HOUSE SEWER
SIGNED TtfIS _—I)AY OF IG -- -------- -- -- -,
y - CONNECT AdGITIJNA[.
EUILDING OR WORK _
OWNER OR j 1 '� d L -- ----I - -_...- --- - ---OWNERS --
AGEN " '-= ,r' x�-�`'_- .-�:' :-z-mss!,•'. SEPTIC TANK,SEEP,PIT(S)
ADDRESS.__ -. � - tNDiOR DRAINFIFLD i -
_ l -YtIRE°Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION r; � I
CESSPOOL,_„ DRYVr'ELLj
.AND STATE ':FIAT THE ABOVE IS CORRECT AND AGREE 70 COMPLY
WITH ALL. COUNTY ORDINANCES AND STATE LAI,'S REGULATING ALTER,REPAIR,SEWER OR i
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HF:RE-BY Cr RTIF'Y THAT I AM PROPERLY REGISTERED ANDlOR DISCONNECT PLUG AND �`_---_i-.--_T-------- —
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF SCONABANDON CT PLHOUSUG
CALIFORNIA OR THAT I AM THt-F:-EGAL OWN13 SHE ABOVE ...__--
DECRIBED RESIDEN,'I.AL PROP L �" BACKFILL SEPT' TANK", 7
r ( ) L CESSPOOLS D r
SIGNATURE „�^- � � SEEP. S __—._ —.— — ----- --- ---- ---OF PERMIT7£ --�-�+_.... �—
I
JOHN A. LAIMBIE, COUNTY ENGINEE VALIDATION ROBERT A.WOOD,CHIEFPLBG. INSPECTOR
;''CK. M. a, CASH $