HomeMy Public PortalAbout9814 OLIVE ST_Sewer__ Af
'IV
CE891'i.C%2
APPLICATION FOR PERMIT
7A.54.2D
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY r)TVISION BUILDING
JOHN A. LAMBIE County EnqiaeorSSC ------
WMLIAM A. JENSEic Supt of Building z'
n-_1 nf�
FOR APPLICANT TO FILL IN 5 5 T.
IDES ?IMON LOT NO. 0NIR
MAIL
ADDRESS
BLOCK 'i RAC
NO OF 51-DGS
SIZE OF LOT NOW ON LOT 114�77 T E L,. NC.
USE
-Ni -6ROU P
BUILDINGS O[S+R'CT c� ""ApPROCESSED BY
DDATA
BK PG
CCN',RACTOR
47
DRESS 17
STATION DEPTH
CITY NO
_EL. -h� 4,-
REGISTRATION NO. El STATE. MN
AHOLE REFERENCE PpER_
COUNTY
Ty
F,OF qONtkrCTION LENGTH FROM
HOUSE 5EWER CONNECTING TO y CURB' P.L. M.L,TO P.L,
SEWER
- - -I P.C.110.
SEPTIC TANK.SEEPAGE PI'y OR
PITS AND/OR DRA[NrIFLO ) CO. Imp� NO. JOB NO.
VaC1)
q&U!SE SFW ERCONNIECTING TO- - - - TRUNK PERMIT NO. ROAD PERMIT No.
-
0
PRIVATE DISPO';AL SYSTEM, @ $3.00
07
-1 NO. DATE
CONNEC-T�ADDITIONAILBLD
G OR W .
VIT AIVER 1 EAEFENT-T RECORD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT.r-RAINr;ELD
E)IrN.C�SS-,C)OL.DRYVVE'-L..M.AN�iOLE@ S500
I HWY.OR ST.WIDENING
ALTER.REPAIR 7OR DON HOUSE
SCZF.R OR DISPOSAL SYSTEM S300 - ----------- ------
STATE ENCROACHMENT
PERMIT NO.
I NOUSTRiAL
WASTE APPROVAL
OPERMIT
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL'FEE ,Lz ' -., I -------- - - - -
4 HAVI. AT T'HIS DATE A CONTRACT WITH THE HEREIN NA I MED CON- REIMBURSEMENTFEE
TRACTOR TO CONNECT THE APSOVE DESCRIBED EXISTING DWEL.I-IUG
'To THE PUBLIC SEWER, APPROVALS
DATE INS-PEC rOR 9 SIGNATURE
�'-91 GNEID THIS----RAY
;:P W N-R OR NEW HOUCF BEWER
OWNER G.AGENT------
DT
ONNECTADliON AL
Aor'Rrss BUILDING OR W"�JR K
SEPTIC TANK,SEEP,PI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL!CA ION AND,'OR DRATNF,ELO
AND STATE THATTHE ABOVE 15 CORRECT AND AGREE I'D COMPLY
,WITH ALA- COUN"-Y ORDINANCES AND STATE LAWS REGULATING
PLU4PJNG AND SLWERS CFSFF'OOL q DRYWELL
CERTIFY THAT I AM PROPERLY REGiSTERED AN�','OR ALTER,REPAIR SEVVER OR
I "`L-�rEay
L4C-ENSFD AS REQUIRED BY LOS ANGLES COUNTY AND STATE CF SEWAGE 015PCISAL S-,ST'FW,
C.A.:
Ai-WORN I A OR THAT I AM. 7HE LEGAL OWNER OF, AND INTEND TO
-RIBED PIAL, D[SCOIN' NECT PLUG AND
HOU.
st
F5!,,E IN, THE ABO)il-DESC RES�DENT;A ABANDON SE N.
TEE DACFILL SEPTIC TANKS 0
Ck'sqpooL4
SEEP.
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANCAL ENGINEER
K Rf.D ASH