HomeMy Public PortalAbout9635 OLIVE ST_Sewer__ 76A642D 'APPLICATION FOR PERMIT
E-663 11-55
D1,VISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
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JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
I_ 7
NEAREST
FOR APPLICANT TO FILL ,IN CROSS ST..
LEGAL F/�
DESCRIPTION LOT NO. OWNER
4MAIL
BLOCK TRACT ADDRESS_
Nb. OF BC6GS,
SIZE OF LOT'J ✓, 44�1411 ON LIT CITY TEL, NO.
USE OF
BUILDINGS
G S
_0
DISTRICT N_ GROUP MAP
P0
BK 14
_U NHTRA�q(K
ADDRESS CONNECTION DATA
ST
CITY ATION 4- DEPTH
TEL. NO�
MANHOLE PEFERENCE,3,/,.
/0 STATE 0 W.
ER
REGISTRATION NO. COUNTY e
No.
DESCRIP'I ION OF WORK FEE
HOUSE SEWER CONNECTING-TO TYPE OF CO .TION LENGTH FROM
P.L. M.L. To P.L,PUBLIC SEWER @ $3.50 __Y_
_/_1SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C, NO.
ENT N.,CESSPOOLCONNECTING
MAN HOLE CW $2.00 �Cl It�. NC. OB NR._
__
HOUSE SEWER ONNECTINGTO
PRIVATE DISPOSAL SYSTEM (a $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR
STATE ENCROACHMENT
WORK TO HOUSE SEWER (g- $1.00 i PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
@ INDUSTRIAL
SEWER OR DISPOSAL SYSTEM
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 5 I 100
-_ REIMBURSEMENT FEE
TOTAL FEE
AUTHORIZATION
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN APPROVALS DATE INSPECTOR'S SIGNATURE
i NAMED CON-
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PU!3c_1C SEWER. NEW HOUSE SEWER
SIGNED THIS----DAY OF
CONNECT ADDITIONAL
OWNER OR
BUILDING OR WORK
OWNERS AGENT—
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR D_RAjNFIELD1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL, DR WELL
AND STATE, THAI HE. PROVE IS; CORRECT AND AGREE TO COMPLY --------
WITH A[L COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR.
PLUMBING ANID SEWERS.
SEWAGE DISPOSAL SYSTEM
T HEREBY CER'TIFY THAT I A'A PROPERLY REGISTERED AND!OR
OR
LICENSED AS R-QUIRED_BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR IHAT--] AM THE: LEGAL OWNER,' OF THE ABOVE __��AN�0�HOUSE SEWER_
VESCRIBED RESII)ENr
AL PROPERTY,.— BACKFILL SEPTIC TANKS[I
$ A SEEP.PIT(S) �j CESSPOOLS I:j
Z
IOHN A.' AMBIE, COUNTY ENGINEER VALIDATIONROBERT A.WOOD, CHIEF PLED, INSPECTOR
CK, M. 0.