HomeMy Public PortalAbout9215 OLIVE ST_Sewer__ C
45ae42D �2 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELESo
DEPARTMENT OF COUNTY ENGINEER �E E�--�E�/AC'�E DI��Q�/��
BUILDING AND SAFETY DIVISION BUILrING _` �
JOHN'' A. LAM—BlE, Cotknty Engineer ADDRESS a
WILLIAM A. IENSEN. Supt of Building P
LOCALITY
- - V`1EARES7 f
FOR APPLICANT TO FILL.,IN CROSS__-L GAL
+ T.
CESCRIPTI>N LOTNOl_ "' (d g '� S f t fY OWNER
__
MAIL
BLOCK TRACT ,yfr. ADDRESS
NO, OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TFL. NO.
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Of
HS)LD NGS DISTRICT NO. GROU¢? MAP PRpCT�.:-Sf'D 8Y
"PRO
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CONTRACTOI? , 7 F 1 r ,1` "
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ADDRESS
y CONNECTION DATA
CITY STATION DEPTH
NO. /
STATE NHO,E REFERENCE --___.—____
REG tS7 RAT'Olt NO. v— C. _�/ {7A,pJtdTY LOWER
Np GESCRIF'TION OF WORK FE.E _ TYPE OF CONNECTION —. LENGTH FROM CL
—.—_
!
HO—USF SEWER CC)i<iNEC iNG Tp Y: CURB P I M.L TO P,L.
F JFILIC SEWER n $S,Ot7
SEPIC TANK SEEPAGE PIT 03i 1 P C NO,
PITS AND/OR DRAINFIELD @ sT0.p0 I co,IMP NO JOB NO
HOUSE..SEWER CONNECTING TO �-- TRUNK PERMIT NO. _-- ROAD HERMIT NO.
j PRIVATE DISPOSAL SYSTEM $3,00 L
l
CONNECT ADDITtO*7AL BLDG.6R g.# AFP'IDAV IT'[WAIVER EASEYtN' I RECUFLf.!NS R NO.� DATE
W'7RK TO HOUSE SEWER $300 __ _ Lu
r
_ __ �.-__—
OVERFLOW SEEPAGE PIT,.DRAiNFIELD !
____ .LE 12 $5.00
EXTN.,K:E __ --ORYW€Y.I_,MA MANHOLE ,�'
ALTER.REPAIR OR ABANDON HOUSE —_ _.__.—__ },WY.OR$T.Vd i.DEN-NG
SEWFR_OR D S'PO5AC SYSTEM $300 STATE ENCROACHMENT
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PERMIT NO,.
INDUSTRIAL.
IAPPd
1 WA�yfiE, ROVAL ,v p
owl l PERMIT $j 2 00 —� RAE
CONNECTION CHAR,E r EF r
[x - ----
AUTHORIZATION TOTAL FEE ---" - -� --------------------'-------
1 HAVE AT T-1.5 DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
CONNECT 'rHE A5nVE D'ESCRTEiFD EXISTING DWELLING ---- ----- -- - ---- -- ----------
CW9CT�R 'fp y5
r0.THE PUBLIC SEWER. �'R
ER. APPO Y�y A
S � DATE I INSPECTOR S SIGNATURE.
SIGNED THIS DAY "
OVVN R OF, NEW NOJ SEWER
_ _ ____
O>,V NE4 qGF_hfT_. .CONNECT ADDITIONAL 1 Y I
BUILDING OR WORK J -
F.DOPE
' PTIC TANK SEEP, T`s) f�
.HEREBY A KN,.WLLDGE THAT I HAVE 1EAD THIS APPLICATION ANO/OR DRAINFIE D
Ai4D StAIF THAT THE: ABOVE I$ CORRECT AND AGREES r0 c.OMPLY
wfT;-I AL,L COU T' ORDINANCES AND S7'A;'E LAWS RE'.GJLAT;NG '
CESSPOOI I
YI_J Mf3'iNC. .AND SEW_R3. ❑ C4YWE',LL ❑ I
HRKSY CERTIFY THAT I AM PROPERLY REGISTERED AICD;OR ALTER REPAIR,SEWER OR
Ll CCN EO AS HE0L;RF0 BY LOS ANGLES ^.O iJN'rY AND S'TAIE. OF SEWAGE DISPOSAL SYSTEM
AM TN E' LEGAL OWNER'. OF, AND INTEND TO —_- --__ _______
I
C.x.LiF JRNiA OR CHAT D;SCO NOd EC'r PLD, AND
RESIDE Inl, THE ABOVE DESCRIt3 Llz RESIDENTIAL PROPERTY.PROPERT`f.
A"cfl NDON°HOUSE SEWER.
5'GNA1 .'Rr' BACKFILL SEPTIC TANKS
OF PERMIT TEE
-�-- SEEP.Pi,(S) El CEaaPOOLS ❑1
_-VALIDATION ROBERT A. WOOD
sUPERViSING MECHANICAL ENGINEER
M.O: CASH
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