HomeMy Public PortalAbout9537 OLIVE ST_Sewer__ 5083,_62`
6A6420 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBI E. COUNTY ENGINEER ADDRESS' ,l
COLEMAN W. JENKINS, SUPT. OF BUILDING -- ^-
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CRd55 ST. - -
L
DESCRIPTION_ LOT NO /,.-y - ---- OWNER
MAIL
v ;..- l" ADDRESS
BLOCKTRACT I� _ _- _
_NO. OF BLDGS.
SIZE OF LOT NOW ON LOT ' CITY TEL. NO.
BUILDINGS fP b DISTRICT NO. GROUP MAP PROCESSED BY
PG
CONTRACTOR"
ADDRESS �. ._ '- ,, �. CONNECTION DATA
CITY _�, -�L. NO. - STATION y- s--. J fr DEPTH
STATE +' `":' LIC MANHOLE REFERENCE. t1 - '-`], '^y'.$ UPPER
LICENSE NO._ ! -Ly' OLA55 ,.i �._ ''_J,T �.1�._ _
NO. T DESCRIPTION OF WORK FEE TYPE OF CON NEGT—ION --3 LEN6-rH FRO
HOUSE SEWER CONNECTING TO I Y CURB P.L. M.L70 P.L.
PUBLIC SEWER $5.00 i P.C.NO.
SEPTIC TANK,SEEPAGE PIT OR -
CO,IMP. NO. �{ ".-., JOB NO.
PITS AND/OR DRAT
NFIELD @ $10.00 I —.-- ] —
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.<
'RIVATE D POSAL SYSTEM @ $3.00 1 + /'
TC ON NECT ADDITIONAL BLDG.OR AFFIDAVIT TWAIVER EAS EM[Nt RECORD. INSTR.NO DATE
W QRK TO HOUSE SEWER_ _ $3.00 —�� Lu
OVERFLOW SEEPAGE PIT.DRAIN�IELD I'`J
E XTN..CESSPOOL.DRY WEIL.MANHOLE _$5.00 j en
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING z
SEWER OR DISPOSAL SYSTEM STATE ENCROACHMENT
-_. PERMITA .
f INDUSTRIAL
—� WASTE APPROVAL
i
OWNERS RMIT S 2 00 CHARGES
PE
AUTHORIZATION
CONNECTION CHARGE FEE
TOTAL. FEE ---
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING —
TO THE PUBLISEWER. APPROVALS DATE INSPECTOR'S SI&NATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER ' -
OWNERS AGENT_
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPT iC TANK..SEEP,PIT(S)
I
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY -- - -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU MB ING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR _
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE A E DESCRIBED RESIDENTIAL PROPERTY.. ABANDON HOUSE SEWER j
SIGNATURE ACKFILL SEPTIC TANKS ❑
OF PERMITTEE_
SEEP,PIT(5) ❑ CESSPOOLS ❑�
-VALIDATION JACK R. ALLEN
CK.
M.0, CASH SUPERVISING MECHANICAL^ENGINEER