HomeMy Public PortalAbout9602 OLIVE ST_Sewer__ E-663.'x.55 E
61 •66
78 EAPPLICATION FOR PERMIT
5
DIVISION OF BUILDING FIND SAFE Y SEWER-SEWAGE DISPOSAL,
Department of County Engineer
County of Los Angeles BUILDING
WPI.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT 0.GRIFFIN,SUPT of BUILDING LOCALITY
FOR APPLICANT' TO FILL IN NEAREST
CROSS ST.
LEGAL -
DESCRIPTION LOT NO. OWNER -
BLOCK TRACT r - MAIL—__�___�.�__. -
�r ADDRESS
NO. OF BLDGS.
51ZE OF LOT _ NOW ON 1.0T CITY TEL. NO.
USE OF _-
BUILDINGS - - _ DISTRICT NO. GROUP 1 ASAP
CONTRACTOR BK P6 u
ADDRESS CONNECTION DATA
L C.7Y TEL. NO. STATION. DEPTH
❑ STATE MANHOLE REFERENCE
REG,I•STRATION NO. ❑ COUNTY -- -- —.----------._—.�-
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO —__ 1-- 'TYPE OF CONNECT"... LENGTH FROM
PUBLIC.S=WER _ Ca) $ 3.50_!. I -., Y.--____...CURB _ PL _M.L_TO P,L.
HOUSE SEWER CONN CTING TO
----PRIVATE DISPOSAL SYSTEM 1.00
CCFdNECT ADDITION�tL BL DG, OR —I P. C. NO.
SV URK TU HOUSE S£SA�c.R 7.00 CO. iMP:_N O_� - JOB NO.�
—�
ALTER OR REPAIR EXISTING
OR DISPOSAL SYSTEM 1.00
TRUNK PERMIT VOA_—__- ROAD PERMIT NO.
StStER _
NNECT AND ABANDON SEWER STATE ENCROACHMENT
AND,'0_R DISPOSAL SYSTEM I,G6 — PERMIT NO
--� SEPTIC TANK,SEEPAGE PIT OR '---------"-------- -- .
PITS AN D!OR D_RAINFIELD 2.00 . -INDVSTP.!itL
7 — — -- ------- —JWASTE F,PPROVAL _I I
CESSPOOL DRYW ELL
SPECIAL COti DITW' ONLY 2_00 CHARGES r
IiIvIIT'�— 11 C3 CONNECTION CHARGE FEE
OWNER'S PE —' _--- -
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE 'THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS yy�RO pq�T
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING P ALS DATE �INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS _____.DAY OF
CONNECT ADDITIONAL __�_—_----
OWNER OR -
OWNERS AGENT BUI"_DING OR WORN
'� _----
-
^-----__--! --`—�------- _SEPTIC TANK, FiEL PiT(5) 71—
ADDRESS— SEPTIC ANK, EEP. ii
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[C� DRYWELL❑
AND STATE 'THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAMS REGULATING pL7ER, REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT 2 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY .AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ASA_NDON HOUSESEVVER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ � T
SEEP PIT(S) ❑ CESSPOOLS❑ - �.[
SIGNATURE
OF PERMITTEE_.
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
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