HomeMy Public PortalAbout9011 OLIVE ST_Sewer__ S�
'E808
10-63
6A6420 APPLICATION POFD PERMIT .,/ ,?
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION TNE
I DING
JOHN A. LAMBIE, County Engineer RESS -- — �
WILLIAM A. JENSEN, Supt of Building
— -- -----
LOCALITY
RS T
FOR APPLICANT TO FILL IN 53 ST
.--._LFGAL
DESCRIPTION LOT NO �- I OWNER
MAIL.
BLOCK TRAC'. ADDRESS
NO. OF P.LO0 S.
SIZE OF LOT NOW ON LOT CITY TEL. NO,
USE OF -
BUILDINGS - jf�-- � DISTRICT NO. GROUP MAP PROCESSED BY
BK PG.
CONTRACTOR
ADDRESS ._CONNECTION DATA
CITY +' ' O� Z"i °` TEL NO. d $ ""' eSTATION DEPTH
�. STATE MANHOLE REFERENCE'
REGISTRATION NO. r �� COUNTY �,
NO.. I DESCRIPTION OF WORK FEE ---TYPE O F CONNECTION 11 LENC.Li FROM -
i HOUS£$EWER r_ONNEi'.TING 70 _•- � Y. CURB vtd.L,. - M.L.70 P.L. �.
PUBLIC SEWEP
-J - - - -- _.._ .- - -__ -_ --_- P.C.NO. .�--
__ SCF
-_ _--_. -
� 5 DTIC T. h!<,SEEPAGE Pt7 OR � `
PITS AND/OP.GRAINFIELD @ $10..00 CO.IMP NO: ;� ,' .1OB NO. 0
T.r_—__ I.�7
HOI.:SE SEWER 'fit NC. T1NG TO -_�--moi TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATEDSPOSAl SYSTEM @
--__-_._._ .._.�-.._
CMF ECT qDD 7!ON ALBLDG..Oft I AFFIDA VLT I WAIVER i EA.S EMEVT RECORll.!NSTR NO. DATE s
WORK'T:O HG SE SEWER Q $3.00 j -
OVERFLOW SEE-AGE PIT:bRPiNF1ELD
C-N.,CESSPOOL,ORYWEL L,MANHOLE.@ $55.00 ' ^
-._._. HWY.OR ST.WIDENING
ALTER.R�PA.IR OR ABk NDON HOUSE
' E _ __
-____
._.____
- _____ __.__ m�SEWER OR DISPOSAL SYSTEM @ $3,00_ -TA7FNOAE
PERMIT NO.
INDUSTRIAL
j WASE APPROVAL
2i 00
�7t�T�+p�s ._.-
YY lY L7F1T'A _P_E_RM_IT CHARGES
AUTHORIZATION TOTAL FEE ---- ---.-,� - - CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED{CON- R£IMEiJ R5EMENT FEE
T RACT•'JR TO CON
THE ABOVE DESCRIBED EXITING DWELLING
O _-_-.7{_-____________�___.—__
TTHE PUBLIC SE APPROVALS DA'T'E I NSPrCIOR SiGNATU?RE
SIGNED THIS vc.W DAY 0 A A doe.5,..7' 19 '------------------ - -- ------� ....,__
OWNER CTR ,p .NEW HOUSE SEWER 1 1
OWNERS AGENT-.-- d �^Ls_'' A oW CONNECT AODiTIONAL
.. g1'tbu -
BUILDING -_ WORK1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OSEPTIC TANK. F P PiT�SD j �
AND/OR DRAINFI _D {
AND STATE THAT THE A@OVE is CORRECT AND AURES TO COMPLY
WITHALL ALL COUNTY CRC'NANCES AND. STATE LAWS REGULATING 1
PLUMBING AND SEWERS CE65POOL (] URYWELL_
I HERESY CFRTIFY THAT I AM PROPERLv REGISTERED AND/QR ALTER. REPAIR,SEWER OR
LICENSED AS REQU1 RED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM {
CALIFORNIA OR 'THAT I .AM THE LEGAL OWNER OF, AND INTEND TO DIS^ONhf.CT PLUG AND-'--�--_�__^-- --���--
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER I .
" — --- --L -- -— --
#- -
5lOr PERM_ BACKFILL PTIG TANKS
OF PERMITTtE—_- _E :•� "ar-_.—_
- -" SEEP,P T(S; [j CESS POQLS []�,.
__.-'EVALIDATI®N ROBERT A. WOOD
SUPERVISING MECHANICAL. ENGINEER
CK. M.0- CASH -
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