HomeMy Public PortalAbout9324 OLIVE ST_Sewer__ 76AC420
E-4,62 3.5s APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deparbnent of County Engineer
County of Los Angeles. BUILDING
WM.J.FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN, SUPT OF SUILOtNG LOCALITY v
FOR APPLICANT TO FILL IN NEAREST
CROSS ST,__
LEGAL
DESCRIPTION_ LOT NO, OWNER
BLOCK TRACT '7' MAIL
._ADDRESS
NO. OF BLDGS.
NOW ON LOT TEL. NO.
SIZE OF CITY
USE OF
BUILDINGS DISTRICT NO.' GROUP MAP
BK PG
CONTRACTOR
ADDRESS
CONNECTION DATA
CITY TEL. N 0. STATION
DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO. Q1 CGUNTY LOWER
DESCRIPTION OF WORK FEE
HOUSE SEVER CONNECTING TO P
TYPE OF=NNECTION LENGTH FROM
PUBLIC SEWER @ $ 3 L. M.L. TO P.L.
7
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 CCL IMP. NO, JOB NO,
ALTER OR REPAIR EXISTING
I EWER OR DISPOSAL SYSTEM 1.00 71RUNK PERMIT NO, ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND.OR DISPOSAL SYSTEM 1.00- PERMIT NO.
SEP�ilC TANK, SEii;AGCpTT OR
PITS AND/OR DRAINFIELD 2.001 INDUSTRIAL
$SPOOL-DRYWELLSPECIAL CCNDIT{ONS ONLY_ WASTE APPROVAL
-2.00- CHARGES
OWNER'S PERMIT
CONNECTION CHARGE FEE
$ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH "[HE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED -EXISTING-DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
To THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS___DAY OF
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT
SEPTIC TANK,SEEP. PIT(S)
—ADDRESS AND!OR DRAINFIELD
1
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL[3
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTE14
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR. THAT I AM THE LEGAL OWNER OF THE ABOVE SEWER
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS F�
SEEP.PIT(S) 0 CESSPOOLS 0
SIGNATURE
OF PERMITTEE__
WILLIAM J.FOX. COUNTY ENGINEER 'VALIDATION R.A.WOOD, CHIEF PL8G. INSPECTOR
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