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HomeMy Public PortalAbout9471 OLIVE ST_Sewer__ Y8AE-6691f•,TMiS APPLICATION FOR PERMIT 1 i 14 E•6fi DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER -ADDRESS - - -- -_ -- ----- - --^--- - - CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST, LEGAL -------- ---- - -- --- OWNER DESCRIPTION LOT NO. MAIL -------.--.._-�----' BLOCK - TRACT ADDRESS NO, OF B�.I GS. CITY TELT N0. SITE OF LOT _ NOW ON LOT _ USE OF i -- - - DISTRICT NO. i GROUP f MAP BK PG $UiL.DIN.GS � _ -- _ CONTRACTOR. JJ ; _ CONNECTION DATA ADDRESS ---__--`------ ------ --- ._.--__..._-.___-._-.-__.._. CITY -E.. 4_. STATION f DEPTH .9� �-=---=—---- - MANHOLE REFERENCE - (� 1 A 1 - ' _ yyl,tiz LOWER REGISTRATION NO. NO. ) DESCRIPTION OF WORK FEE _ - --- ---- --- -- r TYPE OFC4CTION LENGTH FROM .r _I HOUSE SEWER CONNECTING TO - -- I I Y. URB, P.L. R` L. TO P,L, PUBLIC SEWER, _fo? 3 3._50 --. —I SER TIC TANK SEEPAGE PIT OR - ! PITS AND/OR DRAINFIELD_ _ (e) $3.00 - ---I OVERFLOW SEEPAGE PIT DRAINFIELD -�-� - ,r 's' P. C NO j EXTN.,CESSPOOL,DRYWELL.4 ANHOLE a $2.00� _ CO. IMP. NO. ,�_. JOB NO HOUSE SEWER CONNECTING TO ' ___i_FPIVATE DISPOSAL SYSTEM (a? $1.00 ? TRUNK PERMIT NO. ROAD PERMIT N0. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER (U. $1.00 PERMIT NO. i ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM (>> "�1.00 I ' WASTE APPROVAL 9 - CHARGES CONNECTION CHARGE FEF OWNER°SPERMIT___3 ( 1 ©o —__ _ -- ---------- -- AUTHORIZATION TOTAL FEE iV REIMBURSEMENT FEE I. HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- ___-APPROVALS DATE �INSPECTOWSSIrNATUREE TRACTOR 70 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS. —DAY OF._.:_ 19.-_ CONNECT ADDITIONAL f - OWNER OR - BUILDING OR WORK- -------.�--..L:__—_----------.... OWNERS AGENT_—_---_ SEPTIC TANK,SEEP,PIT(S) ADDRESS- AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ I f AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY —_..__. —. __.-_—. .___ --J WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I &'d PROPERLY REGISTERED AND/OR - �— - '— — I LICENSED AS REQUIRED BY 103 ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND � I - CALIFORNIA OR THAT I Ah, THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDF;TIA.L lkAPERTY. BACKFILL SEPTIC TANKS Lj SNATURE SEEP,P!T(S). 0 CESSPOOLS(_i IG � ,� r � �,-. � -- — --..-.— OF PERM.i)TEIE_ - IOHN A. LAMGIE,COUNTY ENGINEER rVALIDATION ROBERT A. WOOD,CHIEF PLBG. INSPECTOR N, 0. CASH