HomeMy Public PortalAbout9449 OLIVE ST_Sewer__ 7@A
E-66s s-�s APPLICATION FOR. PERMIT
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DMSION OF BUILDING AND SAFETY SEWER--SIEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX,COUNTY ENGINEER ADDRESS v
CASSATT D.GRIFFIN,SuwT op Sult DmoLOCALITY
FOR APPLICANT TO FILL IN NEAREST s # - ----�
_CROSS_ST_ a_,��, x r-m/Ag`
LEGAL F,✓v 3', : ..r -ROSS
DESCRIPTION LOT NO. OWNER j f t'- ;
BLOCK TRACT ,. i ._ MAIL
ADDRESS
- N0. OF BLDGS. .. I SIZE OF LOT ' `. NOW ON LOT -� CITY TEL. NO..
USE OF
DISTRICT NO. GROUP I - MAP
SK PC
CONTRACTOR
ADDRESS _ CONNECTION DATA _'' 9
CITY TEL. NO. w - STATION
'�. t,,_. � ,� �' ---- ---- �¢ � >� DEPTH
STATE MANHOLE REFERENCE R_
REGISTRATION NO. ❑ COU14TY - --�{f •/ _ °"t•`f'_-,__ '� LOWER
NO. -- DESCRIPTION OF WORK FEE �-- ---- ---._.......-- -_--- ---- --- -
---- LENGTH FROM
r HOUSE SEWER CONNECTING TO - Y. CURB -' P.L. M.L. TO P L.
p PUBL'C 5 '1E;2
Hot»S E vcI CONN C_TING TO
PFtiVATE D SAOSAL SYSTEM 1.00'
-- ------ --- ----- ..._.
CONNECT ADDFTiONA" BLDG.OR P. CNO.
WORK I0 HOUS_ESLWER 1.06! I CO. 'F"p NO. _,.'C_B_NO_
-V- --
hL _R OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT N0.
_^ SEWER OR DISPOSAL SYSTEM1.qD +_ _—_.. �°.,_ '�' -
I)iSrONNFC. AND ABANDON SEWER STA
ENCROACHMENT -
AND/0R DISPOSAL SYSTEM _ 1.00 PER _Y NO.
SEPTIC TANK, SEEPAGE PIT OR
_I
PI S AND/OR DRAINFIELD 00� INDUSTRIAL
-`---
-__ D_ _._ -.. '_.__- WASTE APPRO .
--� CESSPOOL DRY4ICLL i
SPECIALCONDITIONS ONLY 2.00 - SES
- - _ CONNECTION CHP,.R F E
-'— -- --
S PERMIT
AUTHORIZA'TION TOTAL FEE -- � _���-- RE111BUR-41.11ENT FEE.
I HAVE THIS DATEC01dTRACTED WITH THE HEREIN NAMED COY-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING AP�FIO�ALS DATE INSPEC OR SS;GNATUkE
I
TO THE PUBLIC SEWER -- - 4 " - --'---.
SIGNED THIS . -DAY OF 19_. NEW HOUSE SEWER
OWNER OR r _CON_N-E-C-A.DD WT^fONFi AL
OWNERS AGENTBUILDING-O?
—�
A➢DRESS SEPTIC TANK,SFEP,PIT(S)
_ AND/OR DPAINFIEc D
I HEREAY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL EI DRYWELL tEl
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE: TO COMPLY
WITH FALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE NSSPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 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 ABANDOI': MOUSE 5 WEP =
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[=
SEEP. PIT(S) CESSPOOLS I __
SIGNATURE
OF PERMITTEE '� - -
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF FPLEIG. INSPECTOR