HomeMy Public PortalAbout9480 OLIVE ST_Sewer__ s a FIIs63 Ix-sa APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles 7ADDRESS
WM.J. FOX, COUNTY ENGINEER CASSATT.D.GRIFFIN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN NEAREST r.
LEGAL /"` t' -- -
DESCRIPTICN6c LOT NO. .. 'z, OWNER
OWNER
_.
BLOCK TpAr_To m MAIL � ._ .- .,�,.�.___�._.,_•_�.. _r,._..
.w.___ �w .1-.w._.-:;,.-'t:. '�.`r6{-.�..."-,..• Lt a_. E..`L ADDRESS
N0. OF BLDGS. ._.e_»
SIZE OF LOT -NOW ON LOT' CITY TEL. NO.,
USE OF ..-.
SUILDINGSTFZA
DISTRICT NO, � GROUP I ASAP
CONTRACTOR t BK PG
ADDREss CONNECTION DATA — -
CITY
TEL. NO. DEPTH
�1 STATE F,( :titiOC.EREFEi?ENCEREGISTRATION N0. El COUNTY LOWERNECTION LENGTH FROASyO, I flESCRSF71OPd OF WORK FEE P.I.. ,t.{.ToP.tl—HOUSE SEWER CONNECTING TOPUBLIC SEWER (3' � 3.50HOUSE SEWER CONNECTING TO PRIVATED;SPOSAL S`<STEMf.00
CONNECT ADDITIONAL BLDG. OR If CO IMP. NO JOB.-NO. `
WORK TO HOUSE SEWER t.b4_!
ALTER OR REPAIR EXISTING
—f SEV,'ER OR DISPOSAL SYSTEM _ 1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
—„^
1 ll SCONNEC AND ABANDON SEWER
—I i STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1_100 I PERMIT N0.
—��SEPTIC TANK,SEEPAGE PIT OR
PITS AND,'OR DRAINFINDUSTRIAL
'IELD ? 00 -
-- CESSPOOL- DRYWELL-- I"IASTE APPROVAL
f
PECIAL CONDITIONS ONLY - .2.00 I CHARGES
CONNECTION CHARGE FEE
OWNER'S FEfta'�21T s 1 ! 00 -----
AUTHOEIZATION -TOTAL FEE� REIMBURSEMENT FEE
I PIAVE THIS DATE. CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT 'THE ABOVE DESCRIBED EXISTING DVIFLLING APPROVALS DATE. INSPECTORS SIGNATURE
TO THE PUBLIC S'::-'..'.ER
NEW HOUSE SEWER
SIGNED THIS__DAY Or---- .______ t9.�.__
OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT_ BUILDING OR V{ORK�__
-- - SEPTIC TANK,SErP, PIT($)
------_-'— AND/OR DR.AINFIELD _
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION -CESSPOOL,[j DRYWELL❑
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY TUAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THA.Y 1:AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL-PROPERTY. BACKFILL SEPTIC TANKS[�
SEEP. PITS) Q CESSPOOLS❑
SIGNATURE
OF PERMITTEE -
WILLIAM J. FOX,COUNTY ENGINEER VALIDMION
BY
DEPUTY DEPUTY
BY BY
DEPUTY - DEPUTY