HomeMy Public PortalAbout9726 OLIVE ST_Sewer__ aE-663 1t•55 D
5APPLICATION FOR. PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING - r
JOIN A. LAMBIE,COUNTY ENGINEER ADDRESS
-CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY_
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,
LEGAL7"' t7F7Z `.�c... OlNNER- ✓ ..r -_ _. -
DESCRIPTION LOT N5.'
MAIL
BLOCK TRACT - 1 ADDRESS
LrJ y'' Cr NO OF BLDGS. CITY �`` TEL. N0.
SIZE OF LOT X „/ NOW ON LOT .f
USE OF
_BUILDINGS - err" e - DISTRICT NO.. ' GROUP i MAP
RK PG
-- —
CONTRACTOR__ .>d:ry - ..:� 9'v'"� ---
� CONNECTION DATA
ADDRESS ---- --
d �.,�' <_ STATION _ ,,T'% �. -------DEPTH --- ___
CIT'_-Y ` - MANHOLE REFERENCE "--- UPPER
-
STATE __ ____ .✓'A !'. _sas4t
REGISTRATION NO, �"'` �""� COUNTY
NO, ; DESCRIPTION OF WORK rEE ------ --- -- -- ----
i- --- --- - --- - - -- -- ,,...---.. TYPE OF CONNECTION —LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P.L. M,L,TO P,L.
PUBLIC SEWER $3.-
_._ ,. ._ .,0_ _ --- - --'---
SEPTIC TANK,SEEPAGE PIT OR I
PITS AND/OY DRAINFIELD r $3.00 -- - -- --------. _�- -�--�- -
OVERFLOW SEEPAGE PIT,DRAINFIELD _ ,y P. C. NO.
EYTN ,CESS UOL,DRYWELL,M.AfdtiOLE !a $2.00 CO, 1MP. NO. L�` JOB NO.
C HOUSE SEWER.CONNECTINGTOI
PRIVATE DISPOSAL SYSTEM rte. $.1.00 1 TRUNK PERMIT NO. ROAD PERMIT NO. Vii. �`✓„�ry
i CONNECT ADDITIONAL BLDG.OR- ` STATE.ENCROACHMENT ---- -_ -----_ ---- `--- --
WORK TO HORSE SEWER Q, $1,00 ! PERMIT N0.
I ALTER,REPAIR OR ABANDON HOUSE ----------------------------
i INDUSTRIAL
SEWER OR DISPOSAL SYSTEM_ - @ $1.00 A — WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEL
OWNER'S PERMIT 5 1! 00
AUTHORIZATION TOTAL FEE ---� a ,-- REIMBURSEMENT FEE i`--- --- ----APPROVALS DATE iINSPECTOR SSIGNATURE
-`--
'
I HAVE AT THIS DATE A CONTRACT WH ITHEREINAMED CON-
TRACTOR TO CCN.NECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER_ NEW HOUSE SEWER E
SIGNED THIS.—_-_._DAY OF _.— 19_--.- CONNECT ADDITIONAL _---
OWNER ORBttILDINC OR WORK
OWNERS AGENT ;.' ,'.rrA_.,1y --- - --- --- -�- j'
-
SEPTIC TANK,SEEP,PIT(S) --- --_ _- _
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
CES5POOLj] DRYWELL-❑AND SPATE THAT THE ABOVE IS CORRECT AND AGREE T'0 COMPLY
WITH ALL COUNTY ORDINANCES .AND STATE LAWS REGULATING ALTER REPAIR SEWER OR � �-
PLUMBING AN9 SEWERS SEWAGE DISPOSAL SYSTEM -
I HEREBY C'RT FY TH T I AM PROPERLY REGISTERED AND;OR - -- ---- ------
LICENSED AS EOJIRED BY LOS ANGELES COUNTY AND ST '£ OF DISCONNECT PLUG AND
t-
CALIFORNIA OR THAT ,j AM THE LEGAL OWNER OF TH ABOV ABANDON HOUSE SEWER.
DESCRIBED REQ DENTI ROPE.TY. /' BACKFILL SEPTIC TANKS{
SIGNATURE .,.�' SEEP,PITS) G CESSPOOLS`1
OF PERMITTEE - --- I
JOHN A.LAMBIE,COUN NGINEER yi IDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. 111�0. CASH