HomeMy Public PortalAbout9705 OLIVE ST_Sewer__ 6
,sA -66'3 1.1.f55? APPLICATION FOR PERMIT
3$ -68 -
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING --�"
JOHN A. LAMBIE, COUNTY ENGINEER -ADDREss --
CASSATT U. GRIFFIN, SUPT OF BuiL.DIN G LOCALITY ^_
NEAREST
FOR APPLICANT TO FILL IN GROSS ST. _
LEGALafti°
DESCRIPTION LOT NO - - _--4f - -" fe --' -` --'•
- RIPTI ---- w _ MAIL
BLOCK TRACT . .301)ej-�'J -nDDRESS -----' ---
q. OF BLDGS. �, CITY TEL. NO.
SIZE OF L�OTI ._,NOW ON LOT
Use OF -
BUILDINGS DISTRICT NO GROUP MAP PG
CONTRACTOR :.." x. 'i --- �'
ADDR S ---_ CONNE TION DATA - _--
STATION , DEPTH _
ad' _ - _- � ___------ -
CITY -"I'�. � )t L, x0. -"'. - - ---- ---- - -
MANHOLE REFERENCE UPPER
SnTE
REGISTRATION N0. ".',�. _ � '� ❑ COUNTY --
Vs�' r r
----- = c .
xq. � pESCRIAT(QN 4F WORK FEE ---------- ---
---- --- ----- --- ------- ---- TYPE OF CONNECTION LENGTH FROM - - ----
HOUSE SEd�f-R CONNECTING TO Y. CURB P.L. N.L.TO P,L.
PUBLIC SEWER @ $9.50 - .. --- --- - - - ----- --------
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DR,AINFIELD
OVERFLOW SEEPAGE PIT,DRAINFIELD -- ' i - P. C. N0. _ ----
cRTN..,CESSPOOL,DR YW ELL.MANHOLE (.1 ;>2.00 CO. IMP. NOJOB NO. _-_---.-`
HOUSE SEWERSP CONNECTING TO I .BUNK . _
PRIVATE DISPOSAL SYSTEM (<z $1.00 PERMIT NO, ROAD PERMITNO.
4 I CONNECT ADDITIONAL,BLDG.OR -; STATE ENCROACHMENT
IJ01K TO H OUSC SEWER (a $1,00 ; ' PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM c $LGO —_ WASTE AP.R, VAL ,
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 UC7 --------
.-- ..-...-- -- -- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- _ APPROVALS - +- _DATE �INSPECTOR$SIGNATURE
,RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
TO HE PU3LICE:y R. NEW HOUSE SEWER
SIGNED THIS S DAY 0 - _�� Yy __' cgxNECT ADDITIONAL
OWNER OR 2 , '� , � BUILDING OROWNERS A
--- -'- SEPTIC TANK,SCEP,PIT(S)
`zADDRESS ha AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL ED DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGRE'.E TO COMPLY --_._.-_-__.__.-_ -----_--- -�-� _----�---_—__--
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -----_------- --'-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER_ I I
DESCRIBED.RE81D NIAL PRO RTY. _ BACKFILL SEPTIC TA14KS❑
r SEEP.PIT(S) ED CESSPOOLS
SIGNATURE11,
e - P. -- --- - �- -
OF PERMITTEE 1 1,
IOHN A. BIE, UNTyY*E'hLGI ER w VA ATION ROBERT A. WOOD, CHIEFP>_BG. INSPECTOR
Q 1 M. P CASH