HomeMy Public PortalAbout9646 OLIVE ST_Sewer__ t
:EvGB 10-63 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL U"
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION �'.;+LOIN; Y
JOHN A, LAMBIE, County Eng neez
ADDRESS
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WILLIAM A. JENSEN, Supt of Building y
LOCAL.T j # ,af� "�J
NE AREST -
CROSS 'ST
FOR APPLICANT TO FILL IN -
DESCRIF rI iN _ -- ___--
OT NO OWNER ',r
LOCK
MAIL
RA C.T ADDRESS
B .rte
NO. OF PLDu S.
SIZE CIF LOT _ NOW ON LOT C Ti` .EL.. NO,
USE DISTRICT NO. GRO U F,, MAP PROCESSED BY
BUILD S ,mss ✓ BK PG
CONTRACTOR '�
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t $ADD RESS CONNECTION DATA
STATION ._— f DEPTH
CITY TEL. NO -
ST'ATE UPRER
MANHOLE REFERENCE
REGIS I'RATIO
FJ NO. w �? _ COUNTY r k-'>?EM ��
DESCRIPTION OF WORK FE � -TYPE OF CONNECTION T � LENGTH FROM
uC.JSE SFW[ri COFJNEC iNG -Eg ___ —_� __ Y,, CURB P L. M.L TO P L. y
PUBLIC SEWER @ $5.00 -,C-2
— —_—
^ ..�SEPT C TANK SE EYAGE PIY OR —____ ---_ --- P.C..NO
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CO, IMP.NO. JOS N(S
PITS AND Oil DRAIN IF.i_U .�?O.Dfl __ —___.__ .—�.__— __.—.— _.
HOUSE SEWFR CO.NNF".TING TO
TRUNK PERMIT NO. it'OAU PERMIT NO:.
PRIVATE DISP_SAI_SYSTEM = 33.00
,
_— __—__._ O.
CONNECT AVDIT' ONAL SLOG.OR � AFf iDAVIT rWAiY¢N{ [A9 EMEkY r RECORD.?Nu'TR NO, I DATE
— -
._ WORK TO HOUSE SEWER _ -_ � $3.00
OVFRFv r l'�W EE.PAGE P?T DRALNFIELU
EXTN CE-5SFOOL,DRYN LL,MANHOLE @ $5.00 .:
__— HWY.QRST.WIDENING
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ALTER,RFP IR OR 48A NOON F'-OVSE
Cd/ER OR D SPOSA Y:.'7EM _.,$3.00_ Si,I TE:.EtJC ROACHM`eNT ,.._.
i PERM?'r NO
INDU>T'RiAL
WASTE APPROVAL
— CHARLES
OWNER`S PERMIT z oo --- ----- ----- ----------
.--._ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE x - - ----------- - ------.__.___--
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT F_£
TRACTOR YO CC)7NECT THE ABOVE DESCRIBED EXIST] DWELLING - '— —D—ATE
'
TO THE PURL SE`WER,� I DATE INSPECTOR'5 GNAiURE
,� APPROVALS
SIGNED.THIS �DA OL=, 19
OWNER OR NEW HousE w�ER t
OWNERS.AG'c'NT
CONNE;T ADDITIONAL
ACCs BUILDi N:G OR WORK
R1:5S _ _ _
- - — - - ---- SEPTIC TANK,SEEP,PITS)
iI �HERFBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAIN+.ICLO
AND STATE THAT THE ABOVE IS `" COMPLY
CORRECT AND AGREE fi0 --.------ i--- ---------------
WITH
ALL COUNTY ORD114ANC55 AND STATE LAWS RE rs ULP.:7INv i i
PL'J MTi(NC AND SEWERS- CESSPOOL ❑ DRYWELL
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGYSTERED AND/OR ALTER REPAIR,SEWER_OR
Li I_ENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF 5E.WAGE DISPOSAL SYSTEM 1
CALI?-ORNIA OR THAT I AW,T'HE' LEGAL. O�` ,'�pJEEE OF, _AND INTEND TO DISL:fJN NECS PLUG AND
2ES i DE IN. THE ABOV" _DE^ft'CRi BED RE$44)V-iTIAL, ROPERTY. ABANDON HO USESEWER
5'r GNA.YURE — J" ,�"�Ja.
OF PERMITYE� '� ' , _ BACKf!LL SEPTIC TANKS'
SEEP,PIT(SJ ❑ CESSPOOL,., C�
r .-VALIDATION ROBERT A. WOOD
r_K. M.D. CASH SUPERVISING MECHANICAL ENGINEER
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