HomeMy Public PortalAbout9138 OLIVE ST_Sewer__ - 6
Sa E- 6a r2-sa APPLICATION FOR PERMIT' 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles
WM.J. FOX. COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT OF OUILDINGLOCALITY ��
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. ✓"r"
LEGAL - -- - -- -
DESCRIPTION LOT NOOWNER
BLOCK TRACT MAIL
ADDRESS,
NO. OF BLDGS.
SIZE OF LOT` NOW ON LOT CITY µ TEL. NO.`-
USE OF
HUILDING9, ar
.-_.__� -�-'-�--`=------(_.�_3.-.._�_ _ {��('� — DISTRICT N0. � GROUP i MAP
CONTRACTOR C,k S Y19f co IST.ppCO. BK PG
ADDRESS 1117 CGLC.1 t".fr1V E ,t i F. _
` cOrrlyECT1011 DATA
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CITY `'� a i'"'' '.... TEL. NO �.. ..,i:: STATION DEPTH
'! n "C 2' ' 4 ❑ STATE MANHOLE REFERENCE
REGISTRATION NO. ;.-I COUNTY � _ �.� F-r_=n- _ LOWER"-` TYPE OF CONNECTION _ LE NCTIi FROM -.--
NO. I DESCRIPTION OF WORK FEE CUPB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO µ ms~
I PUBLIC SEWER C $ 3.50 -
HOUSE SEWER CON14ECTING TO �
__� PRIVAT_E DISPOSAL 5Y T M 7.00
CONNECT ADDITIONAL BLDG. OR IMP
WORK 7_O HOUSE SEWERCO, . N0. JOB. I80.
_ 1.00 ( _
ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD FER!A1"t NO.
�I SEWER OR DISPOSAL SYSTEM 1.00 f -- - T..E
DISCONNECT AND ABANDON SEit ER
;TATE ENCROACHMENT
AND/OF DISPOSAL SYSTEAi 1.00 I _-�- PERMi7 NO.
SE TPC 7A 1K, SEEPAGE PIT OR ---
PITS AND OR DRAINFIELD 2.00 I_ WASTED
7 E PPPROVAL
CESSPOOL DRYN ELL —i I�
SPECIAL CONDITlONS ONLY 2.00 - CHARGES
CONNECTION CHARGE FEE
OWNER'S
PE" 1 00 -
AUTHORIZATION 1__T_0TA_L_____F'E_E _- f�. REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED. CON- APPROVALS DATE , INSPECTOR'S SIGNATURE
TRACfO'R TO CONNECT THE ABOVE DESCRiBLD EXISTING DWELLING
TO THE PUBLIC SEWER
J`-'. s - NEW MOUSE SEWER -
SIGNED THIS A �F - I� J. ---
tfCONNECT ADDITIONAL
OWNER GR + pI -,�•d-'" -i j '--, BUILDING OR WORK
OWNERS AGENT, � _ _ ._._.
iA•-�°' SEPTIC TANK,SEEP,FIT(S)
AND;rOR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[I DRYWELL Q
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITH ALL A1,L COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY C.RTIFY THAT I AM PROPERLY REGISTERED ANIVOR -"`--`
L'CENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE -A!rA- DON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERr7 fSACKFILL SEPTIC TANKS[I
A +" SEEP, PIT(S)_Q CESSPOOLS'�{
SIGNATURE
OF:PERMITTEE I
1
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY
BY BY
0 DEPUTY DEPUTY