HomeMy Public PortalAbout9624 OLIVE ST_Sewer__ ,6Aeazn
&151.663 111.55 APPLICATION FOR PERMIT1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Depax neent of County Engineer
County of Los Angeles BUILDING ,
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS `»O 624 .?.en �,'.!:.l,.ve,
CASSATT D. GRIFFIN, SUP'TOFBUILDING LOCALITY T.'I'd
_ FOR APPLICANT TO FILL IN NEAREST
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DESCRIPTION LOT N0. J, OWNER Y,ri H'1 c ( TI {yy�y-
---- --- ---- MAIL
BLOCK TRACT zu 1 ''j --
-NO.OF SLDGS. CITY v TEL. N0.
_SIZE OF LOT NOW ON LOT'
USE OF -- _
BUfLD1NCS -� - DISTRICT NO. 4 GROUP MAP
Ie :.�i _ I K- BK PG
CONTRACTOR c`i�o13are Deal r.-�'T•..S'�?j'° ��',3':y"'_ ,� y� I }° !v- i
AGDREsS ^C a -- CONNECTION DATA-----
STATION
ATA —_TSTATION DEp7H
CITY t!'W rr'rl.U':_ TEL. NO. LTT rt.,L�{ - r-�"_-- - �-- --
MANHOLE REFERENCE ,-' UPPER
�� _ ] STATE --,_ :. % ,t. - LOWER
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REGISTRATION NOS-l.'"J ,j -ice_ COUNTY
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DESCRIPTION OF WORK PEE - TYPE OF C{N'NECT(ON - LENGTH FROM
HOUSE SEWER CONNECTING TO >' Q'UR P.L, M.L. TO P.L.
I PUBLIC SEWER _ �a. $_3_S0 _ ---- ------ --=—s.' ----
I STAP K,SEEPA PAGE PIT OR.. I- -
PITS AND/OR DRAINFIELD
OVERFLOW SEEPAGE P17,GRAINFIELD {- � ,..� P C.NO,
EXTN..CESSPOOL,DRYWELL,MANHOLE Q, 5 2.00 I CO. IMP- NO-
HOUSE
MP N0.HOUSE SEWER CONNECTING TO ._ ..- `.----f-._._.—_ --- ------ —.----- .— -- -
f PRIVATE DISPOSAL-SYSTEM (ci g 1.00 -TRUNK PERMIT NO. _ ROAD PERMIT NO.
CONNECT AODITIONAL BLDG,OR STATE ENCROACHMENT
WORK TO HOUSE SEINER Czr $I.QO PERMIT NO. -
ALTER,REPA R OR ABANDON HOUSE INDUSTRIAL -
SEWER OR D°SPOSAL SYSTEM EM r' $1.DG
_ --_ WASTE APPROVAL
I � 4
! I CHARGES
CONNECTION.CHARGE FEE
OWNER'S PERMIT 0 ----------_.----
AUTHORIZATION TOTAL FEE _-- � s)r_ REIMBURSEMENT SEMENT FEE �r
I HAVE AT THIS DATE A CONTRACT WITH THEE HEREIN NAMED CON- APPROVALS I DATE INSPECTOR'SSIGNATURE
--- ----r ----
TRACTOR 'T0 CJAIlLCT THE ABOVE DESCRIBED EXISTING DWELLING I
TO THE PUBLI.. SEv,ER, NEW HOUSE SEWER i
SIGNS OR
THIS---DAY OF i9- CONNECT ADDITIONAL
NERSIGNEBUILDING OR:v3RK
OWNERS AGENT—' y --�-- —` ---- -...
SEPTIC TANK..SEEP,PITS; ---
.ADDRFSS -- `-s— AND/OR GRAINFIELD
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1 HEREtY ACKtOWLEDCE THAT I HAVE READ THIS APPLICATION. CESSPOOLLf LRYWE:LL❑
AND STATE Tf C E ABOVE IS CORRECT AND AGREE TO COMPLY �
'LITH ALL COUNTY ORDINANCES AND STATE LAWS RECULAi1NG ALTER,REPAIR,SEWER OR ( 1
PLUMBING AND S J EPS, - SEWAGE DISPOSAL SYSTEMHE cSl' CERTIFY THAT I AN PROPERLY REGISTERED AND/01, UG AND
PLv E ~
LICENSED AS REQUIRED BY LOS AN-; DISCONNECT ANGELES COUNTY AND STATE OF � —�—
CALIFORNIA OR THAT ° Atli THE LEGAL OWNER OF THE ABOVE —ABANDON CTL HOUSE- SEW-E-R-- - —.---
DESCRIBED REST ENNAL PROPERTY BACK ILI L SEPTIC TANKS[j
SIGNATUREj„ SEEP. PI) S) I, CESSPOG, ]
S,
OF PERMITTEE
EOHN A. LAMBIE, COUNTY ENGINEER —VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CASH ..
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