HomeMy Public PortalAbout9212 OLIVE ST_Sewer__ D
SaE-663 19•SS APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL 1
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE,COUNTY ENGINEER _ADDRESS -
CASSATT D. GRIFFIN, SUPT OF BUILDING - LOCALITY
EST -----_ .'--_-------- --------
_ FOR APPLICANT TO FILL IN NEAREST Sr.
LEGAL OWNER
DESCRIPTION LOT NO _ -�_-__ -_-- - --,---- -- �`!
MAIL
BLOCK .,. TRACT ADDRESS -
NO.OF BLDGS.
SIZE OF LOT :' NOW ON LA'; CITY, TEL. NO.
USE OF - DISTRICT NO. GROUP MAP
BUILDINGS _. ,
-- —'- _---' --'-- -- I
-- ----- -
BK PG
CONTRACTOR
ADDRESS t= CONNECTION DATA
-- --"��- --- -STATION '_• �.�.-_... DEPTH Va`` -*.R
CITY f TEL. N0.
MANHOLE REFERENCE �:.. ,s�. k.d ^4 U PER
f,. Q STATE
REGISTRATRON NO, ❑ COUNTY
N0. Dt$CR PTION OF WORK FEE TYPE OF -91U.4CTION LENGTH FROM
/I HOUSE SEWER CONNECTING TO i ,�,( y,- Y. CURB P.L. M.L.TO P.L.
11 PUBLIC SEWER @ $3.50 -- -' - ----'---- - ----
�- SEPTIC TANK,SEEPAGE P{7 OR -
j PITS ANDiOR DRAiNFIELD �k $3.00 j
--. _- -- --- -
OVERFLOW SEEPAGE PIT,DRA NFIELD I P. C. N0.
j kXTN.,CESSPOOL,DRYt ELL.MANHOLE Ga $2•04� (:0, IMP.-N0, �,,,�..��..,. 1D6 NO.
-^ HOUSE SEVER CONNECTING TO
1
PRIVATE DISPOSAL SYSTEM 0 $1.04 I _RUNK PERMIT NO. -- - ROAD PERMIT NO.
} ( CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT - -
_J WORK TO HOUSE SEWER +a $1.00 �� �.� PERMIT'NO.
-- -- ---_ _..-- --------- ----- ---
_j --
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM -_-_`(u $ „00 WASTE APPROVAL -
CHARGES _
_--- --_ _ -_ -- --_f CONNECTION CHARGE FEE
-
OWNER'S PERMIT ,
j �o --- — ---- ---- — ---- _.__�
.' ---"--- REIMBURSEMENT FEE
AUTHORIZATION TOTAL F--EE---
EE a � APPROVALS
I)A E INSPECTOR'S SIGNATURE
-- I
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN .NAMED CON- -_-_--
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
'0 THE PUBLIC SEWER, 14EW HOUSE SEWER
SIGNED THIS_-_ DAY CSF __ -..19-.-_ coNNEcr ADDITIONAL I
OWNER OR BUILDING OR WORK
OWNERS AGENT _SSSS..
..------- -_ SEPTIC TALAR,SEEP PiT1S
ADDRESS ASND/OR DRAINFIELI)
-._-._. .---- ---_ ..-- - ---.._ ..--`- --- SSSS..__- -
1 HEREBY AC}NOVv LfEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELLO I
AND STATE THI4 1HE- ABOVE IS CORRECT A14D AGREE. TO COMPLY
WITH ALL COUN CY ORDINANCES AND STATE LAWS RFGIJLATiNG ALTER,REPAIR,SEWER OR j
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I -
----- _--i-'---------------------
i HEREBY CERTIFY THAT I AS! PROPERLY REGISTERED AND:IOR DISCONNECT PLUG AND '
LICENSED AS REQUIRED BY.LO> ANGELES COUNTY AND SPATE OF
CALIFORNIA OR THA 1 I THE LEGAL OWNER OF '@HE ABOVE ABANDON HOUSE SEWER -
DESCRIBED RESIDENTIAL P OP R7Yf. 3` BACKFILL SF.
SEEP. PiCESSPOOLS
P11C TANKS j
' T tS�1 t_T ❑ I
SIGNATURE r. _ SSSS- ---- - --- - - - r- —� --Y--- ----
OF PERMITTEE _ g..�,_- 5 } _ .g, I �- --
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JOHN A. LAMBIE,'COUNTY ENGINdtR VALIDATION ROBERT A. WOOD, CHIEF PLaG. INISPECTOR
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