HomeMy Public PortalAbout10520 OLIVE ST_Sewer__ 76A54$D -
i III E-6$3 14•55 APPLICATION FOR. PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
.JOHN A. LAMBIE,COUNTY ENGINEER _ADDRESS,.,
b CASSATT D. GRIFFIN, SUP'YOFBUILDING LOCALITY2�
_ FOR APPLICANT TO FILL IN CROSS S
APT.
`LEGAL —
DESCRIPTION LOT NO. - OWNER ;r
j MAIL
BLOCK TRACT — .ADDRESS
SIZE -
NO. OF BLDGS,
NOW ON LOT CITY 7£L. NO.
OF_LOT _
USE OF
> - DISTRICT NO. GROUP MAP
BUILDINGS �F'Jr"� ,,, _��� r B)�y PG
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ADDRESS' .r�. ' . ----�-
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CITY �.pr,•p fNO. r✓.�a�' ,mss,✓.'. +� -,MANHOLEREFERENCE
17
REGISTRATION N.O ,/ `D COUNTY --`-�--
_ �- r1 COUNTY
NO. DF.SCR[PTION OF WORK FEE - -- —
I HOUSE SEWERCONNECTING TO
-- - TYPE OF CONNECT` , LENGTH FROM �-"
- -PUBLIC SEWER _ @ -Fr-.Y:5.0! CURB__ P.L '" M.L.TO P.L. ,_ ?
d SEPTIC TANK,SEEPAGE PIT OR
_ !
PITS_AND/OR DRAINFILLDco $'+..00
OVERFLOW SEEPAGE PIT,DRAINFIELD -�— — `P. C. N0. -
EXT N..,CESSPOOL,DRYWELL,MAN HOLE $2.OD{ --_ _CO. IhdP. NO._ ! .;?�' JOB NO.
HOUSE SEWER CONNECTING TO T -
_ j PRIVATE DISPOSAL SYSTEM $9.06 � � TRUNK PERMIT N0. ROAD PERMIT NO. _
CONNECT ADDITIONAL BLDG.OR STATE FNCROACHMENT — �-
WORK TO HOUSE SEWER (r $f.00 -__ I' PERMIT NO.
-- - --- -- - - — --- ------ ----`- -- ----------- --._T_.-
j ALTER,REPAIR OR ABANDON HOUSE-- INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM (rn $.t;00 ! WASTE APPROVAL
CHARGES
_CONNECTION CHARGE FEE
OWNER'S PERMIT oD -- -- — ----- -----------
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
AUT
I � f3-
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDcow- i APPROVALS If`I` DATE j INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
---- ----._------------`I- .—..---. ._--___.
TO THE PUBLIC SEWER, •- ,,i NEW HOUSE SEWER
SIGNED THIS _ , DA-Y , a z /'- 19 _
� CONNECT ADDITIONAL
G OR WORK
Q'A OWNER AGEN SEP7IDCN°ANK,SEEP.PITS) --1'----
OWNERS AGENT .�L d ,/r".cd, ss°'3'
_2ADDRESS AND`OR_DR AINF 1 ELS
t H REPY ACKNCYNLEDGE THAT 1 HAV, READ THIS APPLICATION, CESSPOOL❑ DRYWELL 0
AND STATE THAT HE ABOVE IS CORRECT AND AGREE TO COMPLY
eVIFH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLU?I P!N G AND SC JrRS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR --- - - - ^�----__-- --�"-LICENSED AS S R '1IJIPED BY LOS ANGELES COUNTY AND STATE CF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE. ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTI ROPE-. Y " r`' c�y^�ca vL SEPTIC TANKS
.�'''� .✓',�.r-„-r....... SCSP.PIT(S)i ; CESSPOOLS�j j_ I -
SIGNATURE -- - -- -- - .---- ------- -
OF PERMITTEE
j !
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PLEIG. INSPECTOR
CASH
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