HomeMy Public PortalAbout10616 OLIVE ST_Sewer__ 76AE APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL.
Deparhnent of County Engineer
County of Los Angeles BUILDING
WM.J.FOX,COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT OF SUILoma LOCALITY
FOR APPLICANT TO FILL IN NEAREST f
CROSS
LEGAL �.*� -
DESCRIPTION LOT NO. Yom,--..,,,,y C.�' OWNER -
BLOCK TRACT ' _MpU4Ess_
NO. OF BLDGS,
SIZE OF LOT _ NOW ON LOT a CITY TEL,NO.
USE OF
BUILDINGS DISTRICT NO. ' GROUP ! MAP
BK PG
CONTRACTOR E-- t.. - 1 r� IY,9'
ADDRESS CONNECTION DATA
STA ON e._.: ..te�aa-- DEPTH
CITY Y TEL. NO. I` `,( =��'._- ----- --_-*-_.-^ tl_ __.
-- --
0.. $TATE MANHOLE REFERENCE
REGISTRATION NO__-- 3, -'-'--LJ COUNTY
'NO. DESCRIPTION OF WORK FEE --- -
HG1iSESSEWER CONNE..LING 70 TYPE OF CONNECTION LENGTH FROM r
�T PUBLICS '11 ER (J_.: ,7y Y' �i�r� _„cam hi L. TO P.L._
$ 3.SD �' Ret -sad--_.._.—_.._._._ -_----
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG. OR P C N0. �--- _-'-
WORK_TO HOUSE SEA VIR 1,001 � CO. IMP NO
ALTER OR REPAIR t{I ING
EWER OR DISPOSAL SYSTEM 1_00 TRUNK. PERMIT NO. ROAD PERMIT 140. d
ANDIOR DISPOSAL
ABANDON SE`dJER
SYSTEM 1,00I STATE ENCROACHMENT
SEPTIC TANY
SEEPAGE PIT OR -- { HERMIT NO
-_ P175 AND OR DRAINFIELD __..�.` OD_ INDUSTRIAL �!
_.-- -'..------- WASTE APPROVAL
CcSiP00 DRYWELL --- -
SPECIAL CONDITIONS ONLY 2.00
-i -- --
CHARGES,
-' - -- CONNECTION CHARGE FEE
OWNER'S PERMIT
AUTHORIZATION TOTAL FEE ( t�1�F-� RE!MBURS_MENTFEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- �7q �7Y��t�}�� q®pNyg oo
TRACTOR TO CONNECT 'rHE ABOVE DESCRIBED EXISTING DWELLING d'9 PPROVALTS DATE �iHSFECTOR'S SIGNATURE
TO THE PUBLIC SEelER --- --- _- �-_-�- ,-- --NEW HOUSE SEWER
SIGNED THIS. DAY OF�_
OWNER O '� CONNECT ADDITIONAL
OWNERSBUILD�hG_OR_WORK _
SEPTIC TANK, SEEP, PIT(S) -- — -�
ADDRESS_..__ AND/OR DRAINF!ELD
I HEREBY "ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL D DRV VFLL C
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO.COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR SEWER OR
SEWAGE DISPOSAL SYSTEM
i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE RBANDCiN FIOU S E SEWER _
DESCRIBED RESIDENTIALI"ROP£RTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP. PIT($)0 CESSPOOLS
OF PERMITTF
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
I�Ld$'1ril�.