HomeMy Public PortalAbout10528 OLIVE ST_Sewer__ 7�
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
10HN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of building LOCALITY
NEAREST
FOR APPLICANT TO M IN CROSS ST. 2,i Z, &v L
LEGAL
DESCRIPTION LOT OWNER
44
L
BLOCK TRACT MAIL
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT
USE OF CITY TEL. NO.
[BUILDINGS Re is DISTRICT NO. ROUP MAP PROCESSED BY
BK PG
CONTRACTOR
.Able Constr. "'K
ADDRESS 225 W. Bryan Ree,
CONNECTION DATA
CITY EI Monte TEL.NO. I*j. 8-6565 STATION z�-3 ,�63 DEPTH
168579 STATE MANHOLE REFERENCE UPPER
EEGISTRAjjq�N NO._ H COUNTY- ER
NO, ® SCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR (YY. CURB P.L. M.L.TO P.L.
?ITS AND/OR DRAINFIELD $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN-CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO PC.NO.
PRIVATE DISPOSAL SYSTEM si.00 CO.IMP. NO. L�1-"k JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER $1,00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE @ $L00
SEWEYSTEM STATE ENCROACHMENT
R OR DISPOSAL S
PERMITNO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWN s PERMIT $ 1 21 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE -1 1 L-, '� REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT 'THE ABOVE DESCRIBED EXI-STING DWELLING APPROVALS R'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS-DAY OF 19-- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_ BUILDING OR WORK
ADDRESS SEPTIC TANK,SEE?.PIT(S)
AND/OR DRAINFIELD
I HEREBY. ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS C 0"ECT AND AGREE I'D COMPLY CESSPOOL n DRYWELL ❑
WITH ALL COUNTY ORDiNANCFS AND STATE LAWS REGULATING —
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AW"THE LEGAL� �WNER OF THE ABOVE
DESCRIBED RESIDENTIAL PRqf'PERTY. BACKFILLSEPTIC TANKS E]
SIGNATURE SEEP.pl-I(S) E, CESSPOOLS El
OF PERMITTEE, '""
bi, VALIDATION ROBERT A. WOOD
U.0, GAS!i SUPERVISING fyIECHANiCAL. ENGINEER .