HomeMy Public PortalAbout9426 OLIVE ST_Sewer__ 788
CE60811-57 APPLICATION ION FOR PERMIT
7
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL e�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AoflRss ��' ' ✓ w' c
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building % y
- - LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. �A LI `�
LEGAL
DESCRIPTIO LOT NO. •r OWNER
v
BLOCK J 'a i<` .MAIL
TRACT ADDRESS
/ i s `
NO.OF BLDG$.
SIZE OF LOT r9 ;r;' f as�, + NOW ON LOT _.• CITY ✓.',y f^ •�- '>'< 1( ANO. '<
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
CONTRACTOR � ''' BK PG
�� y
ADDRESS ��! ,; .� CONNECTION DATA —
CITY �,4j1 A .' TEL. NO. ' -r(l " 1 STATION DEPTH
STATE- MANHOLE REFERENCE UPPER
REGISTRATION NO. H COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
P 8LI SEWER CONNECTING TO Z--
PUBLIC TANKER @ $S.° TYPE OF CONNECTION LENGTH FROM
SITS A TANK,SEEPAGE PIT OR Y. CURB P.L, M.L.TO P.L.
PITS.AHID/OR D.RAeNFIELD � $3.00
OVERFLOW SEEPAGE PIT,DPAINFIELD
EXTN.,CESSPOOL,DHYWELL,MANHOLE
-
p $2:OC
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE ADDITIONAL
SYSTEM— @ aL00 CO.IhiP.N0. J08
ALDiTiON0.
CONNECT NAL BLDG.OR - -
WORK TO HOUSE SEWER (b $1.00 TRUNK PERMIT N0. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00. STATE ENCROACHMENT
�— - PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT E I , 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• -
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS_ I DATE (INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS—_ DAY OF--I g_ N€w xouSE SEWER —
OWNER OR - - CONNECT ADDITIONAL '( - -
OWNERS AGENT BUILDING OR WORK
ADDRESS. SEPTIC"TANK,SEEP,PIT(S)
.—.---_--... _ -- AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE T'0 COMPLY CESSPOOL'-.—I DRYWELL❑ - _WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,.REF'ACR,SEWER OR
PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER _
DESCRIBED RESIDENTIAL PROPEF€'Y _ BACKFILL SEPTIC TANKS
'� _f SEEP.PITS) [I CESSPOOLS
SPGNA7URE �rf --
G PERMITTEE `� ( Q-
VALIDATION ROBERT A. WOOD
CK. M.o. asfa SUPERVISING MECIIANICAL,ENGINEER