HomeMy Public PortalAbout9110 OLIVE ST_Sewer__ 908 a APPLICA ION i:•OR PERMIT
9908 _ss 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING --
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, SuP't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. cf
LEGAL p �k 1
DESCRIPTION LOT N0. � ` OWNER
.FLOCK TRACT J 9 ri'. DD
A ,
.J 7 ADDRESS
.— N0.OF BLDGS,
SIZE OF LOT &' NOW ON LOT CITY TEL. NO.
USE OF
EUILDINGS ..7 „. _y_ DISTRICT NO.. GROUP MAP PROCETP BY
�_ Yy BK PG I
CONTRACTOR
ADDRESS c,+
CONNECTION
/..;
CITY 6 r E._.. TEL.No.. , '' '' Sr rION DEPTI ._.
rt
STATE MANHOLE REFERENCE NQ COUNTY
4 . 9amy , r— r LOWER
ESCRIPTiON
_
OF''WORK rFE
HOUSE SEWER CONNECTING TO �
PUBLIC SEWER @) $3,0Q
' TYPE OF CONNECTION LENGTH FROM :.
SEPTAN TANK,SEEPAGE PIT OR Y. CURB P,L. M.L.TO P.L.
PITS AND,/OR DRAANFIELD @ $g,OQ -�—�----;-'--
OVERFLOW SEEPAGE PIT,DRAINFIELD _,_r ��`� !` ✓ �, :I _.: ,a
EXTN.. CES:PJOL,DRYWELL @ $2..00
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM ,51.00 CO.IMP. NO.. "? .JOB NO.
CONNECT ADDITIONAL BLDG.OR @ 51.00 ra, --�y
WORK TO HOUSE SEWER TRUNK PERMIT NO. ROAD PERMIT NO.i t:' J
ALTER, REPAIR OR ABANDON HOUSE —STATE ENCROACHMENT
SEWER OR DISPOSAL SYST/E $1.00 PERMIT NO.
f :gid *•�_%�._i ^" INDUSTRIAL. -
WASTE APPROVAL
CHARGES
OWNERS I PERMITTr CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE �" REIMBURSEMENT FEE
1 '!A* AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. '
TRAC''OR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER>
SIGNED THIS._ DAY OF 19_ _ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_ ✓ -
, �
d BUILDING OR WORK
ADDRESS _ SEPTIC TANK,SEEP.PIT(S)
-- -- _AND/OR DRAIN.FIELD
I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL M DRYWELL C�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,SEWAGE PAIR,REPA7k,ASYSTEM
SEWER
OR
I HEREBY CERTIFY 'THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PL GAND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE. IAL ROPERTY. BACKFILL SEPTIC TANKS C7
SIGNATURE S4P,FIT(S) ❑ CESSPOOLS
OF PERMITTE
)' VALIDATION-- ROBERT A. WOOD
-_ CK,
U.D, CASH SUPERVISING MECHANICAL ENGINEER
SA64EDE8�ys ' APPLICATION FOR PERMIT
a
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL `
DEPARTMENT OF COUNTY ENGINEER
BLrII.DING AND SAFETY DIVISION BUiDrNG
ADDRESS
IOHN A. LAMBIE, Count Engineer
CASSATT D. GRIFFIN, Sap t of Building LOCALITY AAw
NEAREST
� Alat T . CROSS ST
— LEGAL - _
DESCRIPTION LOT NOe ..y�• OWNER
BLACK 'TRACT --
+
, MAIL
ADDRESS
NO.OFBLDGS. ---� v.,.
SIZE OF LOT lR� NOW ON LOT CFTY TEL. N
USE OF 11 mmalmw�
BUILDINGS _ � �'' q-OX7
MAP PROCES, D BY
CONTRACTOR PfBK PG
ADDRESSGONNEGTION RATA
CITY TEL.Na. ✓ DEPTH
y
�- ❑ STATE MANHOLE REFERENCE �Ra
REGISTRATION NO. fr [j COUNTY �� ' �.'V d {., ""LgWER
N0. DESCRIPTION OF WORK FEE' — -
HOUSE SEWER CONNECTING TO
PUBLIC 3EWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC f A NK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/ORDRAINF1ELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD J
TPCESSPOOL.DRYWLL a $x00 E 'k- :{ --. -
HOUSE SEWER CONNECTING TO P.C.NO.
PR VATS DISPOSAL,SYSTEM @ $5.00 CO,IMP.NO. a' JOB NO.
CONNECT ADDITIONAL BLDG,OR T P
_WORK TO HOUSE'SEWER !il $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.�ss' ,
-
.ALTER, P,EPAIR OR ABAN�Ei�I:OUSE STATE ENCROACHMENT
.SEWER OR DISPO AL SYSTEM @ $1.00 PE,R:d9if`N0.
INDUSTRIAL
WASTE APPROVAL
_ CHARGES.
OVMEWS PERMIT s Q 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FRE Y REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTon'S SIGNATURE
TO THE PUBLIC SEWER. -�----�
SIGNED THIS DAY OF 18— NEW HOUSE SEWER
OWNER OR _/J_;✓y CONNECT ADDITIONAL ..
OWNERS AGENT- w' '` .- -" BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIEL➢
I HENTY ACKNOWLEDGE THAT I PAVE" READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYW+EI_L []
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE'DISPOSAL SYSTEM
I HEREBY CERTIFY WHAT I AM PROPERLY REGISTERED ANG/0R —SEWAGE DIS PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT
HOUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RiS1DENTIA PROPERTY, �C BACKFI�_LSEPTIC TANKS C1SIGNATURE -
sF S rEP.PIT(S) CESSPOOLS 1
j
OF PERl4t , [J
VALIDATION `` ROBERT A. WOOD1
SUPERVISING MECHANICAL ENGINEER