HomeMy Public PortalAbout9155 OLIVE ST_Sewer__ 7
6A 642 D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS__
---------
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST
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.FRD.,
FOR APPLICANT TO FILL IN
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MAIL.
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DISTRICT NO. G OCESF, D BY
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ADDRILiS CONNECTION DATA
CITY TEIL. NO STATION -.DEPTH
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MANHOLE REFL-R
ENCE/
RE:Gi� TRATIONNO,--- OUNTI
NO, CESCRiPTION OF V ORK FEE .,--_TYPE OF CONNECTION LENGTH FROM-,
Opt,s SEWERCONNECTINGTO
;E- CURB P.L.. M.L.TOY.L.
LSCWER $5.00 0
P.C.NO,
5,'Ell-IC'TANK.SEF.?AGF PIT OR v
JOB NO.
Com I MR:
P i T S 4,N0 0',i D R' 1 N E LD IIJO 00 Pn�
HOUL SEWEUNNECTNG TO --'RUNK PERMIT NO. ROAD PERMIT
�R!VAT::IJ AISYSTEM $�3.00
5- TR
CONNF.f.T ADD!Tiu.'NAL SLOG OR -17DAVIT WMViRl-T ECORT.). tNSTR NO. DATE
as
AFF I EASEMENT ON T
WORK r.)"OUISE SEWE @ f3,00
OVEHFLOW SEFFAGE PIT.DRAINFIE-16 ---
EXTI,.,C.ESFPC)OL,DF?YWELL,IiAt4HOLF.@ V5.00
ALTER,RLAIROR HWY.OR ST.WIDENING
SEW ER OR.DISPOSAL SYrTE�I'
STATE ENCROACHMENT
FERMIT NO,
INDUSTRIAL
WASTE APPROVAL
OWNEYST--j-PEwMiT 2'! -0- CHARGES 0
LONNFCTION CHARGE FEE
AUTHORIZATION I -TOTAL j-E
r m
I HAVE AT THIS DATE A CONTRACT' Wll'H THE HEREIN NAMED CON- REIMBURSEMENT FEE
r R��CTOR TO CO` FCT THE ABOVE DESCRIBED EXISTING DWELLING
T P L N
0 i-}IE U9 Ic S=-WER' APPROVALS DATE I INSPECTOR'SS;GNATURE
S!GNED THIS DAY OF—
0 WN E R 0R NEW:`)OUSE SEWER
OWNERS AGENT—
CONNECr ADDITIONAL
BU;L.DtNG OR WORK
ADDRESS—
SEPTIC TANK.SEEP,PiT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A�PLICATION AND/CIR DRAINFfELD
AND',STATE THAI T H F ACNE IS CORRECT AND AGREE TO COMPLY -------
WiTALL IOUNI'Y ORDINANCES AND STATE LAWS REGULATING
PLUM.1ING AND SEWERS. CESSPOOL, L7 DRYWELL
I IJEFEBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER,REPAiR.SEWER OR
LI L I
C INSED An RvQ:J IRED 811 LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
AL FOR tA OR THAT I AM THE LEGAL OWNER/CF, AND INTEND TO
N -DISCONNECT' PLUS AND
RESIDE IN.. 'THE ABOVE Dj`scR�BEL) RESH)ENTI41- PROPERTY,
ABANDON HOUSE SEWER
SIGNATURE,
OF PERMITTEE BACKFILL SEPTIC TANKS
SEEP.PIT(S) ❑ CESSPOOLS
-/`--'VALIDATION ROBERT A. WOOD
.01 ) -SUPERVISING MECHANICAL ENGINEER
f CK M.O. CASH