HomeMy Public PortalAbout10550 OLIVE ST_Sewer__ " OO.8
�ESQ8.8-&8 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 'AID D S '.
ADDRESS
JOHN A. LAMBI£. County Engsna®x r �--
CASS.ATT D. GRIFFIN, Supt of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. fi
LEGAL - - — „
DESCRIPTION LOT NO. OWNER y J -
BLOCK � TRACT �I' �� ADDRESS ,.� g
N0.OF BLDGS.
SIZE 07 LOT- NOW ON LOT CITY EL.CIA
USE OF
BUILDINGS DISTRICT Ncf GROUP MAP PROCESSED BY-:-"
BK P6
CONTRACTOR
ADDRESS yZ CONNECTION DATA
CITY TEL.NO. fr 'Ft STATION DEPTH
REGISTRATION N0,
�qy �+pl' f LJ TE MANHOLE REFERS CE UP_PER-
COUNTY
ND. _ DESCR PTION OF WORK FEE
HOUSE SEWER CONNECTING TO f✓:
PUJLIC SEWER @ $3.00 '
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIE.L.D tat $3.00 Y. CURB 4 v
P L > MXL.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD z
EXTN.;CESSPOOLDRYWEL.L,MANHOLE -@ $2.00
HOUSE SEWER CONNECTING TO — '. P.(f.N0. -
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. MP.NO, "� JOB N0.
CONNECT ADDITIONAL.BLDG.OR
WORK TO HOUSE SEWER a $1.00 L TRUNK PERMIT N0.
- ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCRtlA`SHI>Z,ENT
SEWER OR DISPOSAL SYSTEM @ $1.00 �PERMET N0.
—_
INDUSTRIAL - - -
=,<,
WASTE APPROVAL
CHARGES
ovmw5 PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 4 �> REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER,
SIGNED THIS,=A / V I9�.._ _NEW HOUSE SEWER
OWNER OR 1 CONNECT ADDITIONAL
OWNERS AGENT - BUILDING OR WORK
[ABANDON
TIC TANK.SEEP,PIT(S)
ADORES _-__-- /OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYSPOOL DRYWELLQWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGER, REPAIR,SEWER OR
PLUMBING AND SEWERS, AGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND{ORONNECTPLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWN£R THE ABOVEDESCRIBED RESIDENTIAL PRP PERTY. J PFPLL SEPTIC TANKS CESS O0 ❑
SIGNATURE y s�'y
OF PERMI
I
► DATION ROBERT A.WOOD
U.o. CASH SUPERVISING MECHANICAL ENGINEER