HomeMy Public PortalAbout10529 OLIVE ST_Sewer__ T__�� l Y 1 " e Glr
6 -63
6A642APPLICATION FOR PERMIT
20
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FA
LDING �� �� �^
JOHN A. LAMBIE, County Engineer RESS t,
WILLIAM A. JENSEN, Sup't of Building C �
ALITY
REST
FOR APPLICANT TO FILL IN OBB ST. r ��
LEGAL (J 1)
DESCRIPTION LOT NO. OWNER
� ` MAIL
BLOCK TRACT q 0, a. ADDRESS
NO. OF BLOGS. j
SIZE OF LOT NOW ON LOT ` CITY TEL. NO.
USE OF DISTRICT NO. GROUP MAP P OCESS BY
BUILDINGS
BK PG
CONTRACTO ,(
ADDRESa �f [ CONNECTION DATA
CITY L'L(p�.-�. � TELNO.Li q 9— (' S p"r ATION j) DEPTH/0/
-2-1 // J] STATE (l PP
REGISTRATION NO. T''(�J ❑ COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE T E CONNECTION' LENGTH FROM
HOUSE SEWER CONNECTING TO ',R1 RB P.L. M.L.TO P.L. (�
PUBLIC SEWER @ $5.00
P.C.NO. CL
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAIYEN EAECORD. INSTR.NO. DATE O
SE MENT R
WORK TO HOUSE SEWER @ $3.00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD 17.1
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING H
SEWER OR DIMOPAL AL SYSTEM @ $3.00 STATE ENCROACHMENT z
PERMIT NO, 42
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s
AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DA`s OF 19_ �t
OWNER OR �^ /1 1 NEW HOUSE SEWER
OWNERS AGENT V l!
CONNECTADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL Cl
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH T I THE LEGAL O NER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB VE THE
ISIAIIINTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATUREBACKFILL SEPTIC TANKSOF PERMITTEESEEP.PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
Lfw 4 2 8 0z-01 SEP 2 8 1 1 D 2 5.0 0