HomeMy Public PortalAbout10623 OLIVE ST_Sewer__ ' E6&E•8-663 Y1•S5 APPLICATION FOR PERMIT
S&
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY ��,,,
_ FOR APPLICANT TO FILL IN INEAREST
LEGAL t f . 7 — -
DE " -
DESCRIPTION LOT NOOWNER
BLOCK TRACT MAIL
-ADDRESS
NO, OF BLDGS. CITY TEL. NO.
-SIRE OF LOT_ NOW NOW ON LOT
USE OF DISTRICT N0. GROUP MAP
BUILDINGS �" y_� BK PG
CONTRACTOR(!'-.a �„ a, '•f.,1,t- ,+�i..'l �n�f — —' � ��- a'�----
ADDRESS _ CONNECTION DATA _
CITY • _ STATION ._. f DEPTH
TEL NO.�J, �i -
MANHOLE REF;;•RENCE. .
! L�--`STATE —._ - fI�•f• ;d
REGISTRATION NO. �`' ✓. " .', 7 [] COUNTY -
NO.— --DESCRIPTION OF WORK FEE -----
-- TYPE OF CONNECTIO�L LENGTH FROM
�. HOUSE SEWER CONNECTING TO I Y. CURB P L M.L.TO P.L. `
_
PUBLIC_----- _ __ Cry � 5q - -�.�.. �..;'`>�G`-='._. ------- ---_= -- -='�---�----
1 SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAiNFI€LD $3.001 _
� OVERFLOW SEEPAGE PT URAINFIELD � :�� -�; �;-"
£{, d ,CESSPOOL,DRYWELL;MANHOLE ("i s Z.00
__ E.
HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL SYSTEM__ �: 5 1,00 ; RUNK PERMIT NO. ROAD PERMIT NO.
COt•INECT ADDITIONAL 81.DG.JR
STATE ENCROACHMENT
WORK TO HOUSE SEWER Cu S 1.00., PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE, -- -----------"_--
SEWER OR DISPOSAL SYSTEM trll $,..00
INDUSTRIAL
- -_ _.._ _.._ -_--.. WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00 --- - - - — ----
--�-- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT W1Tif THE I4EREIN NAMED CON- APPROYALSj DATE JiNSPECrOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBFL' EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS_ IL—DhY CF_4�a/x_,Z" 19�' —CONNECT ADGt7i0N.AL. --i -- i -- -- —
�
OWNER BUILDING OR WORK
O .ER OR rI`r ,+ - e ......,,,111 _
I ERS AGENT EP'i1CTANK,sEEP PIT(S) ^— —
ADDRESS _„C.� �` .,_..�,� I�.� �'` -. AND/OR DPAINFI ELD ��--
i HEREBY ACKNOWLEDGE THAT /HAVE READ TOIS APPLICATION
CESSPOOLEj DR Y6•.ELL] �
AND STALE THAT THE ABOVE :S U,ORKCCT AND AG,f.EE TO COMPLY"
TH .ALL CC.LL Y ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR � 7
PLUMWNG AND SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND''OR -- -_—�--- —'-'--- -
LICENSED AS REOUiREU 3Y LOS ANGELES COUNT': :,,ND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i ANI THE LEGAL OWNER OF THE ABOVE ABA:ND-ON HOUSE SEWER
DESCRIBED RESIDENT-IA,L R�,PERTY. BACKFILL SEPTIC TANKS C �—
..•
SEEP. PIT I S CESSPOOLS
I '
SIGNATURE J
OF PERMITTEE
JOHN A. L_AMBIE, COUNTY ENGINEER 'VALIDATION ROBERT A. WOOD,CHIEF Pt_EG. !NSPECTOR
CK. M.0 ICA SH,
F