HomeMy Public PortalAbout9842 OLIVE ST_Sewer__ 642D�D_3z APPLICATION FOR P MIT i
'@A64
OT OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BU 1LDINGG^ �.`},�� yyJ ���� '
j0iM A, LAMBIE, County Engineer ADDRESS F' e-.�.a��„-4z-c.,,,' —
WILLIAM A„ JENSEN. Supt of Building
--
LLOCA-I
- NEAREST $'
FOR APPLICANT TO FILL IN
C SCRI T'iON 107'NO _ OWNER -
s MAIL J
At-JLK TRACT j' ADDRESSar✓ ,w"�'"" r(,.- ..___-_-_.__._.__-
- — - -- -_ _74
NOOF St-
L DC.S. --
ZE C :T N'JW ON LOT CITY TEL.. NO.
USE OBU
F ,— DISTRICT NO, GROUPMAP PROCESSE,p 13Y
BK
Cc_NTRAa.,
CONNECTION DATA
11
,�.-� "' S. .i-';r�?_ STATION DEPTH
,jrL'" _ v
s ATC MANHOLE.REFERENCE
RF_G 1...I RATION NO - __ COUNTY
_ --��----
N O.. f CIES.CR[T T-ON OF WORK FEE YY PE,OF CONNECTION LENGTH LENGTHF.fiiOM - ---- 0
- f-- __...
CJSIF SEWER OTdN CYI.7J.v TO Y _CURB -__P L..-�. _ M._7O R
PUBLIC IL SEW Et `kb 00 ; -_ P C NO
- -_.- --_- -
-r 5EPT't-T4NH EEPA�E "4T Oi+ '
PIT A NO/NOR D AINFIELI] @ $10.00 -CO IMP NO. :- __. JOB hO
)JS SEW EIi Gr N aE :YdG r0- TRUNK PERMITNO. ROAD PERMIT NO.
1
PRIVATE P 1;.L SYSTEM $3,00 + f F Lu
_.__.._ -r-__- -I
I CONNECT RDt TIONAL BLOC O - RFFIDA VIT � YJAtvgR I €As€M.t kT j RECORD.;AQ57 R.NO. ( DATE
WORK TO HQE SEWER @ S3.00
II OV.ERFLt>I.k S4:cPA*_,E:.FIT'.GRAINFIELD - � __ _ ..L -_..._-_L.__..__-.._.._..___.
EXTN.,CESSPc OL,DRYWEI..L,MAN HOLE :$:5.00
__.. -_.____.__.-._- ____-__'___-___. HWY.OR..ST.WIDENING
ALTER,REPAIR OR ABANDON HOUSE
EVER ORDISPOSAL SYSTEM $3.00
_.._ STATE ENCROACHMENT
PERMIT NO:
INC'STR,TAL.
WASTE APPROVAL
_.
OWNER'S PERMIT-
0G ES CHA
R g _ _ ____ -__ _ H _ _-
___
CONNECTION CHARGE PEE
AUTHORIZATION TOTAL FEE
I HAVE, A'T THIS DA"_ A CONT'RAC'T WITH THE HEREIN NAMFO CON- REfMBUR5EMBNT FEE
TRACTOR TO CONECT THE .ABOVE DESCRIBED EXISTING DWELLING
TO THE
i E. PU SLIC.SEWER APPRO;yALS i DATE _ N PECTOR S SIGNATURE
-
SI GNED THIS —.--TiAY� F_,
OWNER OR NEW HOUSLSENER
OWNERS AGENT___._ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(5}
I HER.-BY ACKNOWLEDGE THAT' I HAVE READ THIS APPLICATION AND%OR DRAiNFIELD �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNT ORDINANCES AND STATE LAWS REGULATING i
PL MSING AND SEWERS. CESSPOOL DRYWELL ❑
I HEREBY C€RTIF'Y THAT C AM PROPERL GIST EREO %OR ALTER,REPAIR,SEWER OR j
LICENSED AS REQU;RE LOS ANGLES M11TY AND AT OF SEWAGE DISPOSAL SYSTEM 1
CALFORN IOR TH 1 A THC='. LEGAL IER OF' "ND TEND TO -- —' --'T'---�-----------
OF
-- --"`
llISCONNECT PLl7G AND
LL
E �4`E ESCRI'@JEC} RF. D TIAL ROP RT'Y,
ASANC.ON HOUSE SEWER I
_— _— -_—� - -.
EE _ BACKFIL SEPTIC TANKS
—' ----""-_"'-- -- SEEP.PIT(S) CESSPOOLS E]I
VALIDATION-___ ROBERT A. WOOD
CK. M.O. :"ASH SUPERVISING MECHANICAL ENGINEER
rf