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HomeMy Public PortalAbout9729 OLIVE ST_Sewer__ E-2H7vG3 HH.55 ;&T;. APPLICATION FOR PERMIT 1 "s fs DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL Depart>xent of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS J C':A.SSATT D. GRIFFIN. SUPT of E3.1UILOINO LOCALITY - NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL ;✓�. t T� Q".-J° .r -- DESCRIPTION LOT NO,_�e' �- OWNER BLOCK TRACT ---'--------------.---�- ,+. NO. OF BLDGS. CITY TEL. NO. SIZE OF LOTS _.� .. —NOW GN LOT -- BUI OF DISTRICT NO, GROUP MAP BUILDINGS BK PGs CONTRACTOR _._- _ - -'S" I `,-.� -� .f __—. ✓ =...: - — CONNECTION DATA _ ADDRESS - — STATION ,: / DEPTH .„ CITY _ TEL NO.:. -- MANHOLE REFERENCE _ LOWER 1-i STATE —L REG . t iSTRATION NO. COUNTY NO. � DESCRIPTION OF WORK FEE --- —.----- ------ -- _-� - .-- -- _ _._ _ —_--, -- TYPE OF CONNECTION LENGTH FROM — HOUSE SEWS CONNECTING TO Y. CURBv P L' M,t. TO P.L. PUBLIC SEW. R _ @ _ - -- _ .—.,_._g 3_50 ----��----� SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD ;!u $3.00 _� .-3.Y 'r''�''—� ^•z--�-�' — OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0. r EXTN„CESSPOOL,DRYWELL,MANHOLE ) $2.001 CO_. IMP. N0. _1OB NO � t 3 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM (T $.1.G..O ' I_— TRUNK PERMIT NO. R CONNECT ADDITIONAL BLDG,OR ' STATE ENCROACHMENT WORK TO HOUSE SEWER Ctt S 1.02 I PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE .— ---- INDUSTRIAL OR DISPOSAL SYSTE-M 1.©0 WASTE AP R—OV—AL ------ ----._ 1 I - CHARGES CONNECTION CHARGE FEE OWNER'S PEItri4IT $ --� �� , -----`- REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALSI_DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I - TO THE PUBLIC SEWER. NEW HOUSE SEWER SIG111ED THIS .DAY Or—__.__ 19 CONNECT ADDITIONAL i I. OWNER OR BUILDING OR WORK _ OWNERS AGENT ------ ---- SEPTIC TANK,SEEP PIT(S) � ..---- ADDRESS _ _ AND,'OA DRAINFI LH I -HEREBY ACKNOWLEDGE THAT I -HAVE READ THIS APPLICATION CESSPOOL O DRYWELL D AND STATE Ti HE ABOVE IS CORRECT AND AGREE TO COMPLY TH ALL COUNTY ORDINANCES AND STATE LAVA'S_REGULATING ALTER.REPAIR.SEWER OR. "PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM f pt'RF.'( C LTiFY THAT I AM PFtOPEitLYY REGISTERED AND/OR ----- ------ --- __.—_--.��..---__---_.--_._._.,_ �. DISCONNECT PLUG AND .LICENSED AS P,QUiRED BY LOS -ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER , CALIFOkNIA OP. -CHAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED P,ESIUENTI-Asx.PROPERTY. LtACKFILs.SEPT. TANKS(J r-------_----^-- SI- TURE ~.' _SEEP. P 7(S) ul CESSPOOLS I: i t --- ---_------- - -.--__ - .- - ------'------ OF --- OF PERMITTEE - � - - - —� �- JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLEIG, INSPECTOR CK. M.O_