HomeMy Public PortalAbout9454 OLIVE ST_Sewer__ PcPRox.i
N
7BA -66s is-�s
E _ APPLICATION F R PERNHLT - -
a� .ss
DIVISION OF BUILDING AND SAFETYf"'g� :�
Department of County Engineer
County of Los Angeles BU ING y�
JOHN A. LAMBIE,COUNTY ENGINEER ADD ESS-7t
CASSATT D. GRIFFIN, SUP'T OF BUILDING LOG L..
_ FOR APPLICANT TO FILL IN CROSS ST. ' q _
LEGAL -- -
DESCRIPTION LOT NO, , r _ OWNER
MAIL
BLOCK TRACTyd's _ADDRESS
NO. OF BLDGS.
SIZE OF LOT ,, NOW ON LOT-_� CITY TEL. NO,
USE OF
BUILDINGS '-. DISTRICT NO. ( GROUP MAP
------ -- - I BK PG
CONTRACTOR-.. ✓ r'.d`.',,�`� - - -- �----- -'1'�' �'-
CONNECTION DATA
ADDRESS r fr_ - ------ ----- ---- --
_- ` . ,. 1�_� STATION DEPTH
CITY TEL. N0,
-
-- MANHOLE REFERENCE .�' � . -
� ---U PPER
[] STATE
_
REGISTRATION NO f / j�..� � i�_ � �7° ,r•�-- [�--
NO .� DESCRIPTION OF WORK FEE - TYPE OF CONNECTIO- LENGTH FROM
HOUSE SEWER CONNECTING TO�----- - _- --r �„i---
, +,, Y.,-__.---CURB P:.L.. M.L,TO P.L.
PUBLIC SEWER @ S 3.50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD_ _ _ Ci_il_$_3.00 - ----.__-- --.---- .,
OVERFLOW SEEPAGE III,DR INFfELD P. C. NO '
EXTN.,CESSPOOL,DRY_WELL,AANHO_LE rx'_$2.00 I -- �_ ___'•_Qd_: --' ""-- _ ,f `✓ _
HOUSE SEWER CONNECTING TO j -- ---
PRIVATE DISPOSAL SYSTEM $1.00 1 �- TRUNK PERMIT NO. v ROAD PERMIT NO.
'
CONNECT ADD ITIC,NALBLDG. OR I^ STATE ENCROACHMENT -
WORK TO HOUSE SEWER (n g 1.00 PERMIT NO.
„,.., ANDON HOUSE I INDUSTRIAL
_.--
SEXIER
WASTE APPROVAL
CHAR -S
-_-- -- ----..._-�._-.._-
CONNECTION CHARGEE FEE
� . _
OWNER'S PERMIT r DD ---- -- — —.--- ----
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE ( < ay:,
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALSI DATE INSPECT R SSIGNF.TURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EX.STING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS .DAY OF 19CONNECT ADDITION—AL — — — —— —
OWNER OR BUILDING OR WORK
SEPTIC TANK-SEEP,P!T
OWNERS AGE SEPTIC F ,t`_:f _. - (S)
'a., �� -
ADDRESS---- ` AND/OR DRAINFIELD _I
—._... ._ ----- ----
I Ir
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOLO DRYWELLO
.AND STATE -1`0T THE ABOVE IS CORRECT AND AGREE 70 COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,RE:PAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DSSCONNECTD
.PLUG AN —
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE UGA D
CALIFORNIA OR THAT I Aid THE LEGAL OWNER OF THE ABOVE - -=——� -
ER
DESCRIBED RESI DENY 1AL PROPERTY - BACKFILL SEPTIC TANKS D
SEEP PIT ISI (2 CESSPOOLS D.
SIGNATURE ,, s -- -- --- — - ----
OF PERMITTEE' ,�".,✓f, dd .'#�� - r '�r� ,rx.t� `''✓:. �------i--
I
JOHN A. LAMBIE, COUNTY ENGINEE VALIDATION
ALIDATION ROBERT A. WOOD, CHIEF F'LEIG. INSPECTOR
GK, N, 0. CASH t