HomeMy Public PortalAbout9140 OLIVE ST_Sewer__ 70A642D P%APPLICATION FOR PERMIT 1
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DIVISION OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL,
Department of County Engineer
County of Los Angeles BUILDING
WIYI.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST -
c,„,„„ra,
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL ry
---- - - -- ADDRESS
NO. OF B 11.D GS.
SIZE OF LOT' NOW ON LOT CITY TEL.N0.
USE OF
DISTRICT NO. GROUP MAP
___- ---- 3K P''
CONTRACTOR }. I -
ADDRESS CONNECTION DATA
CITY TEL. NO. STATION DEPTH
- — -� STATE MANHOLE REFERENCE
REGISTRATION'N0. II COUNTY _ _ UPPER i._ ._LOWER _
-- -- --- =--H�---s-- - - �
TYPE CONNECTION LENGTH FROM
N0. DESCRIPTION OF WORK FEE _Y. CU3 P_L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER (a);3 -3.5-0
I HOUSE SEWER CONNECTING TO ' -- � _., �•,,, ... f; `,' l a e
_PRIVATE DISPOSAL SYSTEM_ 1.00_I r___-_ ------ —
}
CONNECT AODITIONAL BLDG. OR � i � CO.-IMP. NO. JOB, NO.
WOR_K'TO HOUSE SEWER
ALTER OR REPAIR EXISTING.SEWER OR Di POSAL SYSTEM 1.0OI� TRUNK PEI KIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER
-
ANGDISPOSAL D� OSAL SYSTEM 1.00STATE LNCROAC)'MENT
-L_ It-- PERMIT NO.
SEP iC 1A K SEEPAGE PIT OR -__
_I PITS AND/OR DP.AINFIELD 2.0.0 f�� INDUSTRIAL �a
CESSPOOL ORYWELL --- WASTE APPROVAL
SPECIAL DITIONS ONLY 2.00 I CHARGES
�I _CGN ( i _ - -- --�__
CONNECTION CHARGE FEE
OVMR'S PERMIT s I�1 00 '` ---
AUTHORIZATION ATOTAL FEE , '� � REIMBURSEMENT FEF.
a
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS PATE iNSPEC70R'SSiGNA.?URE
TRACTOR TO CONNECT.'THE ABOVE DESCRIBED EXISTING DWELUNCy
TO THE PUBLIC SEWER - - --'_..- ----- -.��-
SIGNED THIS.__.—.,__. DAY GF 1 NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR
OWNERS AGEN._..-,-..,_.,.__._._.__ BUILDING OR WORK
. _.._.=_..w.... _�_._.._....m,..�._._,.__..—._- SEPTIC TANK,SEEP, PIT($)
_AND/OR DRAINFIELD —�_..
I HEREBY ACKNOWLEDGE THAT I HAVE. READ THIS APPLICATION CESSPOOL 0 DRYWELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -
LICENSED AS REQUIRED -BY LOS ,ANGELES COUNTY AND STATE OF -DISCONNECTLUG AND
CALIFORNIA OR THAT 1 Ahl THE LEGAL OWNER OF THE ABOVE A&A-NDON HOUSE SEWER
DESCRIBED RESIDENTIAL PRDPIITY, BACKFILL SEPTIC TANKS 0
SEEP. PIT M U CESSPOOLS ,.
SIGNATURE - - -
OF PERMiTYE
mm
__1111011111il
WILLIAM J. FOX, COUNTY ENGINrMR VALIDATION
BY
,:1,3BY
DEPUTY DEPUTY
BY BY i
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DEPUTY DEPUTY