HomeMy Public PortalAbout9732 OLIVE ST_Sewer__ E808 10-63
-6A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
7
JOHN A. LAMBIE
County Engineer
W,LLIAM A. TENSE�, Supt of Building
LOCALITY
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FOR APPLICANT TO FILL IN C
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BLOCK TRA C f ADDRESS
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CO?UTRACTOR
CONNECTION DATA
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STATION DEPTH
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STATE MANHOLE REFERENCE
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NO. LE S RIPTION OPVGORK FEE -0 F CONNECTION LENGTH FROM.
Y. CURB P.L� M.L.,TO P.L,;
HOUSE SEWER CO-NNECTiNG TO >I
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PU BLLC SEW ER 1
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SEPTfCCO. I M P. NO
PITS AND/OR DRAINFiELD SI-00
TRUNK PRMIT NO. ROAD PERMIT NO.
S F.S z��, E
CONNECTING 0 b
`R JA E:DiSPOSAL SYSTEM $3.00
r6N NU CT ADDITIONAL BLDG. OR I RECO N�STR DATE
AFFIDAVIT -r--
WORK TO HOUSE SEWER $3.00
MANHOLE@ $500 HWY.OR ST.WIDENING
ALTER.RLPAIR OR ABANDON HOUSE {
SEWER OR DISPOSAL SYSTEM
....... STATE:ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
owl ERMIT 2'; 00
AUTHORIZATI N TOTAL FEE r CONNECTION CHkRGE FEE
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I HAVE. AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMSORSEMIENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO T H E P�,B I IC SEWER. APPROVALS DATE I INSPECTOR'S SIGNATYRE
SIGNED THIS---DAY OF---
OWNER OR. NEW HOUSE SEWER
OWNERS CONNECT ADDITIONAL
BU I L,DING OR WORK
--- SEPTIC TANK.SEEP.PIT(S)
IACKNOWLEDGE THAT I HAVE READ THIS APPLICATION H F RE BY AND/OR DRkINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH
ALL CCI NTY ORDINANCES AND STATE LAWS REGULATING
E
PLUMB
ING ANL) SEWRs. CL SPOOL El DRYWELL ❑
iHEREBY CERTIFY "HAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICEN S FL, AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIF RN.A OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
PLIJIG AND
JDF BLDZSI�D NTIAL 'ER H 0
11 Tit ABANDON Sr 51:1�
R E 51 IN. THE AaOVE DESCRI E PROF
SIGNATUR� BAC SEPTI
OF ITTEE BAC C TANKS
FERM ......
ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
M.O. CASH