HomeMy Public PortalAbout9806 OLIVE ST_Sewer__ E80808
' APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 3 X !
ADDRESS
IOHN A. LAMBIE, County Eagiaeer
CASSATT D. GRIFFIN, Supt of Buil a LOCALITY
NEAREST –
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. �' OWNER MAIL �'/E'
BLOCK TRACT ADDRESS
N0,OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
BK PG
CONTRACTOR
CALI ./rt/� !�" J'S T.=
-
t.' e
ADDRESSCONNECTION DATA j
CITY q6 r TEL.NO. r fi STATION R_ DEPTH
d^ ``
STATE MANHOLE REFERENCE UPPER
�
REGISTRATION N0. ?�' COUNTY �4 `� �'
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ""'" ---
PUBLIC SEWER CO $3.00T a TYPE _CONNECTION LENGTH FROM
SEPTIC JANK,SEEPAGE PIT OR Y. CURB` P.L, M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN_CESSPOOL, DRYWELL
HOUSE SEWER CONNECTING TOP.C.NO.
-PRIVATE.DISPOSAL SYSTEM @ S1.00 C.O.IMP. NO. -' . JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMITNO ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 c
ALTER: REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
S EWER OR DISPOSAL SYSTEM $1.00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I ' ` 1 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. —�
SIGNED THIS QDAY OF %R t91 .n NEW HOUSE SEWER
OWNER OR ;!' �' f CONNECT ADDITIONAL
OWNERS AGENT --e BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
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 DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T A. F AM THE t.EGAL OWNER OF THE ABOVE
DESCRIBED RESIDENOX PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE / ' //! SEEP. PITS [I CESSPOOLS
OF PERMITTEE��r=�
VALIDATION ROBERT A. WOOD
D cAm SUPERVISING MECHANICAL ENGINEER
I ✓ �.'� ...� -wr .- ... _. �' its . __ z':.