HomeMy Public PortalAbout10641 OLIVE ST_Sewer__ CE603 3-62
76A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION qUILD1 I
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A D S'
JOHN ALAMBIE. County Engineer RE 5 41 C) 1 t
WILLIAM . JENSEN, Sup't of Building
LOCALITY C,-T
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FOR APPLICANT TO FILL IN F
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LEGAL
L- NO.
OWNER rb
MAIL
BLOCK TRACT
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S;ZF OF LOT NOW ON LOT CITY
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BIJ!LDINGS 0J571?.(CT NO. GRO MAP PROCESSED BY
CONTRACTOR
ADDRESS
CONNECTION DATA
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STATE MANHOLE,REFERENCE
REGSTRATION NO ',j COUNTY
LOWER
-No. --bEEsCRipTi&4- OF W-6-R-K TYPE OF' tH
LNGT-F
HOUSE SEWER—CON N-ECTI N -'T Y. CURB P.L. NqL.TO P.1:1110"
G
�USLiC SEWER Ccd
$5.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO�
OO. Im.p.NO. JOB NO,
P ,'
_JT5 ANDOR DPAINFfrLD $70.00
HOUSE SEWER CONNECTING'fO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVAIE DISPOSAL SYSTEM S300
W4!VE
C
E CO
AFFIDAVIT we FASC.MEWT R 0
R.NO DATE ONNF(:-, ADr:TiONAL BLDG.OR
WORK 1 0 HOUSE S� ER @ '%'1.00
OVERI'LOW SEEPAGE PIT,DRAINFIFLD
Sr.WIDEN!NG
—j'EXTN.,CFSSP 0 OL,DRYWELL MAN11OLF @ S5.00
ALTER-,REPAIR OR FiOUSE HWY.OR z
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'EW ER OR DISPOSAL--',-YSTFM @
ENIROACIIIIENT
PERM
I NO
INDUSTRIAL.
WA iE APPROVAL
CHARGES
-PERMIT 2 00
OWNEIVS
C
AUTHORIZATION TOTAL FEE ONNECTiON CHARGE FEE
HAVE AT THIS DATE A CONTRACT WITH THE: H IN 111,1 MED CON- REIMBURSEMENT Er
rRE F
T�Na W F':
TRACTOR T 0 CO NNECT THE ABOVE DEScRiSED Lx-fs IN G
10 THE F,UBLIC SEWER. APPROVALS _.
D
SIGNETHiS DAY INSPECTOR'S SIG
OWNER OR NEW HOU5E SEWER
OWNERS AGENT---- CONNECT ADOIT4ONAL
BUILDING OR WORK
s}PTTANK.5VZP�PI-r(9)
I HFRESY ACKNOWLrDGE THAT I HAVE REAL) THIS APPLICATiON AND!OR DRAINFIEt[)
ANO STA'F E THAT THE ABOVE 19 CORRECT ANO AGREE I'D COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS RGGULAYJNG
L. T
PU MaiN G AND SEW E RS�
�,ESSPOIL rRYWELL
I HEREBY CERTIFY THAT AV. PROPERLY REGwrrREO AND/Oq ALTER,RFRA(R.SEWER OR
LI CENSED AS REQUIRED BY ANGLES COONTY AND STATE OF SEWAGE:DISPOSAL SYSTEM I
CA Or, THAT 1 AM OWNER 01, AND INTEND TO DISCONNECT PLt C� AND
.C5�FORNIA
0 Z jN, THE 0 Ell�OE SC E, RCS 1OrNTIAL PROPERTY.
BANDON HOUSE SEWER
51QNATL RE
Pm" y Y/ SACKF.
OF PE, TEE ILLSFPTICTANKS 0
SELP, I-Ff I CESSPOOLS L-j
'VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CASH