HomeMy Public PortalAbout9510 OLIVE ST_Sewer__ S&F..663 12-5.3 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER - ADDRESS ..-•' `q.
CASSATT 0. GRIFFIN, SUp•'r OF SUILDINIG LOCALI7 � A
FOR APPLICANT TO FILL IN NEAR ST
CR S ST,
LEGAL f -
_DESCRlPTION��1.0T OWNR
BLOCK -- TRACT MAIL 3 - r.
-----•--9^Y- ADURESS r _
NO. OF BLDS.
SIZE OF LOT r"" W ON LOT.
_..g._ TEL. No.
USE OF
BUILDINGS STRICT NO. GROUP + MAP
I BK PG
CONTRACTOR
ADDRESS, ..,..,•�. CONNECTION DATA
CITY• . TEL. NO ¢ _ .. STATION -- DEPTH
[e; STATE 3.- MANHOLE REFERENCE -
-REGISTRATION NO. /] COUNTY .._. �� L-F11z`..:- LOWER_
TYPE OF CONNECTiON LENGTH FROM -
NO. j DESCRIPTION OF WORK FEE _.:_. CURBL.- M.L.TO P.L. --
-H-6 ii�_S R_EONiGC72NG TC
PUBLIC SEWER 611 $ 3.56
HOUSE SEWER CONNECT!NG 70 --_
uRl AT;=DISPO AL SYSTEM 1.00 ! - -- -- -
CONNECT ADCtTtOisAl BLDG. OR 1 f,aTD GO IMP. NO. - JOB. NO.
WORK TO HOUSE SEWER I.00 j
ALI.ER OR REPAIR EXISTING
. s'W CR OR 'ISFOSAI.SYSTEPd 1.00 TRUNK P"ERMiT NO, ROAD PERMIT NO. 1
S co NN s P,ND AB �0N SEVt+ER - --
! ANDYOR. C!SPOSAL , STtM__ 7.00 1 STATE ENCROACHS:LN i•
S°QT.0 ANn SEEPA'E PIT OR_�� �i _ PERI MIT NO. _
P s_Aid /GR ID INFIELD 2.00 I INDUSTRIAL�I CESSPOOL DRYWELL — { WASTE APPROVAL
1 SPECIAL CONDITIONS ONLY 2,00 � (�_. - CHARGES
PEa�NrfT -.I-- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ! REIMBURSEMENT FEE_
I HAVE THIS DATE CONTRACTED WITH THE HEREIN. NAMED CON °b �f pCY�+
TRACTOR TO CONNECT THE ABOVE DESC$SED EXISTING DWELLING APPROVALS DATE � INSPECTORS.SIGNATURE
TO HE PUBLIC SI EW .^� - -- ------ —__
SIGNED THIS_ Z DAY OF i9 NEW HOUSE SEER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _B_UILDiNG OR W_O.RK`_--
ADDRESS_._ ® SEPTIC TANK, SEEP, PITS)
___...._..._ _
AND/OR DRAIN_FIELD �_ _
7 19P iE3Y ACKNOWLEDGE THAT I 14A.VE READ THIS APPLICATION CESSPOOL 0 DRYWELL 0
AND a7A,'r•E-THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
V41TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM _
I HE I'SY CERTIFY THAT I AN PROPERLY REGISTERED ANDIOR DISCONNECT PLUG AND
LICENSED D AS REQUIRED BY LOS ANGELES COUNTY AND STA ABANDON TPHOUSE SEWER
CALSFORPiIA 4R THAT S AM THE LF�,6OwNER OF.TFI ADOVE
DESCRIBED RESIDENT�PROPERTY�O r
BACKFILL SEPTSC TANKS❑
,t �' SEEP. PISS?[_j CESSPOOLS{]
SIGNATURE
OF PERMITT f ---- - -
WILLIAM J.FOX.CouNTY GIMEER VALIDATION
Ill 17 4
BY
DEPUTY DEPUTY
B7 BY
(2) DEPUTY DEPUTY