HomeMy Public PortalAbout9714 OLIVE ST_Sewer__ APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depcutinent of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBJE, COUNTY ENGINEER AD.....
CASSATT D. GRIFFIN, SUPtT OF OUILDING
NEAREST
FOR APPLICANT TO FILL IN GROSS ST.
D
LEGL
OWNER j 7
ESCRIAPTION LOT NO,
BLOCK TRACT ADD 5
SjZE OF LOT NO, OFBLDGS. CITY TEL. NO.
NOW ON LOT 6 ✓
USE OF
BUILDINGS BU 'r
DISTRICT NO. GROUP MAP
_
Cast PG
U
7
CONTRACTOR
A AD,DD'P CONNECTION DATA
STATION DEPTH
CITY jEL. NO. L
0--STATE MANHOLE REFERENCE UPPER
LOWER
REGISTRATION NO, / _ ✓
-L1 COUNTY
NO. DESCRIPTION OF WORK FEE
__7 TYPE OF CONNECTION LENOTH FROM
F CURB P.L. M.L. TO P.L,
PUBLIC SEWER
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 14" $3,
— 1 F LD -
OVERFLOW SEEPAGE PIT,6RA I�F NO.
EXTN,,CESSPQOL,DRYVVELL,yAlqil,,)LF +_$.2_00 __CO. INP. NO. 3013 NO..-----I
HOUSE SEWER CONNECTING TO
RIVATE DISPOSAL SYSTEM 0 $1.00 TRUNK PERMIT NO, ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.ORSTATE ENCROACHMENT
WORK TO HOUSE SEWER $I Co PERMIT NO.
REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYS'IEIA c I
WASTE APPROVAL
CHAR G ES
CONNECTION CHARGE FEE
OWNEER'S PERMIT 00 ------
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS JATE A CONTRACT WITH TH E HEREIN NAMED CON- APPROVALS DATE INSPECT OR'S SIGNATURE
TRACTOR TO CONNECT IHE A-BnVE DESCRIPED EXIST NG DWELLINc,'
THE
PUBLIC SEWER. NEW HOUSE SEWER
SIGNED TH1S___.__DAY OF----.--19
OWNER OR COINNECT ADDITIONAL
BUILDING OR WORK
E N T
QWNER5 AG SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIrLD
I.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLL-1 DRYWELL[3
AND STATE THAI THE ABOVE IS CORRECT AND AGREE TO COMPLY _7
NITH ALL COUNTY ORDINANCES AND STATE I-ANS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CFRT;F'i
- THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
AS REUIRED-AY LOS INGtLES COUNTY AND STATE 0.1. ABANDON HOUSE SEWER
'LEGAL A
CAVORNIA THAT� T OWNER 01,34TE E30 Ei
ii,,D RE: 'ILL SEPTIC
" 1_ 2
DE�C�, - _ TANKS 0
STDENTI P 'ov BAqK
ce. Pir(S) u CESSP L D
j, 00 5
'I E
P, eTTEr
6
JOHN A. LAMBIE, COUNTY EN (NEER - VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK.