HomeMy Public PortalAbout10668 OLIVE ST_Sewer__ 76A6427S APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING e
L. ADDRESS_ ti =
JOHN A. AMEIE, COUNTY ENGINEER --
CASSATT D.GRIFFIN. SUP'T OF BUILDINCs —LOCALITY J�r-
FDES:CRIPTION
OR, APPLICANT TO FILL IN CROSS sr_�LOT NO. / OWNERMAILTRACT - ADDRESS NOWOONBLOT E. _
CITY ' ' - TEL. NO.C'4
USE OF DISTRICT N0, GR 02P MAP
BUI.LD1NGS
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CONTRACTOR — _- �"" I L I d_p N �.
CONNECTION DATA
ADDRESS ---- -- --
STATION DEPTH
CITY- -- - 'TEL.N0. MANHOLE REFERENCE —�---- _ UPPER
❑ STATE
REGISTRATION NO. - ❑ COUNTY
NO. DESCRIPTION CF WORK- FEE ---- ----- ------- --
--- TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y= CURS P.L. M.L. TO P,L.
PUB ICS£W E R @ ._
--T-SEPTIC TANK SEEPAGE PIT'OR
__PIT$AND/OR DRAINFIELD ra $33.00_-,_ --: --...--
OVERFLOW SEEPAGE PIT DRAINFIELD P C. NO.
-- EXTN .CESSPOOL_,DRYWELL,MANr,OLF rJ $2.001 Via— _CO, IMP.-N-0. JOB N0;_.
.IHOUSE SEWER CONNECTING TO --- -� —�
T—� PRIVATE_DISPOSAL SYSTEM (rk $1.00 �-- TRUNK-PERMIT NO. _._.__-_-_RO.AD PERMIT-NO
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER C G 1.00 PERMfT NO.
ALTER,REPAIR OR ABANDON HOUSE --- ,. ---- -----—__—.._--
SES+IER OR DISPOSAL SYSTEM $; 0p INDUSTRIAL
_I __.._._ _._._. WASTE APPROVAL
CHARGES
—__i__ .--.--- —_ .—. -- ----- _----J.--
CONNECTION CHARGE FEE '^'
OWNER'S PERMIT -- $ 1 --- 00 --- - ----
AUTHORIZATION TOTAL FEE _F'EIMSURSEMENT FEE
1P '1
F
I HAVE AT THIS DATE A CONTRACT WITH THE HER NAMED CON APPROVALS '_.�._._UAT.E INSPECTOR SSIGNATURE
_._.-—--.._------v._.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXiST1idG DWELLING � I
TO THE PUBLIC SEWER. - NEW HOUSE SEWER
SIGNED THIS-.-----DAY OF----19--- CONNECT ADDITIONAL
OWNER OR BUILDING OR WORM.-__-_--
SEPTIC TANK,SEEP PTT(S}
ADDRESS—— AND/OR GRAINFIELD- ------- --�--.-.___-`^-.-_,-_—----
1 ; FREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAT,ON CESSPOOL 12 DRYWFLL[IA 16 STATE Thal THE ABOVE. IS CORRECT AND AGREE TO COMPLY --__
.�-..-__—.._.PLUMBING AND SEVIIERS. .�-..-__—.._. --__._.,___,...._.—_......__--
wi-H ALL CUNT" ORDINANCES AND STATE LAWS REGULATING
ALTER,REPAIR,SEWER QR �
_SEWAGE DISPOSAL SYSTEM___
I HEREBY CERTIFY THAT ! AM PROPERLY REGISTERED AND"OR DISCONNECT PLUG AND
LICENSED AS REQUIRED EY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I ANI THE LEGAL OWNER OF THE ABOVE --.�----._.----
DESCRIBED RESiDENTIAL PROPERTY. BACKFILL SEP'T'IC TANKS❑
SIGNATURE 22:,? SEEP. PITS ❑ CESSPOOLS
OF PER MITT EE<-'�/i.:L"0 --T• . , . ✓
JOHN A. L.AMBIE. COUNTY ENGINEER V'ALIDATIO ROBERT A WOOD, CHIEF PLEG. INSPECTOR