HomeMy Public PortalAbout9649 OLIVE ST_Sewer__ >BAE-66 3 1 f.53 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL i■
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER --
CASSATT D.GRIFFIN, SUPT OF SUILCDING LOCALITY_. j 1 ___e';.__1_
_ FOR APPLICAN TO FI cross
LEGAL - __�_._ —
DESCRIPTION LOT NO. - OWNER
MAIL
BLOCK TRACADDRE55
NO. OF BLDGS, tr ,
SIZE OF LOT NOW ON LOT CITY/.,, ,y TEL. NO. -
-BUILDINGS USE OF DISTRICT NO. GROUP MAP
CONTRACTOR--
CONNECTION DATA
ADDRESS � � U,er `d �� � —
p.,JSTATION „-
— DEPTH
CITY TEL: NO. r> y, --
_.__.
f .
— — — ��— MANHOLE REFERENCE ` UPPER
3-
-,TATE °3 i L -ER
'�'' 4
REGISTRATION NO, �:+" � .. _s.� .[�., COUNTY — --
NO I DE__ ___ __ OF WORK— .FEE' %- TYPE OF CONNECTION — LENGTH FROM.`'~a�
X_ HOUSESEWER CONNECTINGTO I J "' CURB P L. M.L.TO P.L.
.:_PUBLIC S£1 R C $ .50 I
SEPTIC TAN{ SEEPAGE PIT QR'..__ -- r �"�
—_ PITS AND(OR DRAINFIELD _ fc� $3.004 I _ --- — r--- —
OVERFLOW SEEPAGE PIT,DRAINFIELD
Wi— { P C. NO,
EXTN_CESSPOOL,DR ELL,MANHOLE @ $2.00 CO. IMP. NO,__ v I JOB NO,
I_..
I HOUSE SEW R CONNECTING'PO I
_J_PRIVA7E DISPOSAL SYSTEM ? $9.00 j TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR I STATE ENCROACHMENT
_--�_WORK TO FOUSE SEWER (u $1.00 PERMIT NO.-----
-
ALTER,REPAIR OR ABANDON HGLSE -- - -_- "---- -__��--.—__—
-�—_ INDUSTRIAL.
1.
SEWER R OR DISPOSAL SYSTEM �u,_$L0o �_ - _ _ WASTE APPROVAL
CHARGES
-_---- --- CONNECTION CHARGE FEE.
OiWNEWS PERMIT _ ---=- — - --- ---- —_._.
1 p .— REIMBURSEMENT FEE
'
AUTHORIZATION TOTAL FEE � 1J
I i
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _—�—_--__--_- ---APPROVALS DATE 1NSt ECTOR'-SIGNATURE
—.._.T-----_-..r_- .-_------_..__-----
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSES€W'ER i
SIGNED TN;S__—DAY OF _ 19__
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGEN ewe-_ ,�-.mss° a>+mss .� �_�%i SEPTIC TANK.SFEP, PIT(S) {
AND/OR DRAINFIELD. 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLD DRYWELLD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY -.-_-----.-----_...�.-----`.---__._----
WITH ALL COUN'"Y ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING ANO. SEWERS, SEWAGE DISPOSAL.SYSTE.M I
!
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG:AND
LICENSED AS REQUIRED r3 .;LOS ANGELES COUNTY AND STATE OF I -
CALIFORNIA OF THAT I p,1 THE LECALOWNER OF THE ABOVE ABANDONHOUSE SEWER _
DESCRIBED RESIDYNTIAL,PIROPERTY.
BACKFILL SEPTIC TAN1iS❑
SEEP.PIT(S) ;,.i CESSPOOLS[,} I— _
SIGNATURE -----r ----__.._..---__
OF PERM:ITT€
JOHN A. L.AMBIE, d'6UNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
GY..
N.0 CASA'
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