HomeMy Public PortalAbout9848 OLIVE ST_Sewer__ r
J1..
6Aa420° g3 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEERSEWER--SEWAGE DISPOSAL
BUILDING AND SAFETY DI`/ISION BUILDiN
LOAN A. LAMBIE, County Engineer ADDREss� � � �� .4�
WILLIAM A. TENSEN, Sap`t of Bai:dLzg �
LocAL Tv r! l '_ -- —
NEAREST 1
FOR APPLICANT TO FILL IN CROSS
LEG A
DF +_ F ION, ;T NO OWNER ay✓`>., i� .Z r
MAIL
BLOCK -.,ACT AD D.k G S �'
NO OF SLO'S.
SIZE
OF OT NOW ON LOT CITY TFL. NO.
USE OFJ
BUILD tNC
r "tl: DISTRICT NO, GROUP MAP PROC EP5E4 BY'
t
CONTRACTOR `� 'J" � of �:" �•..�..?
ADDRESS , ,,�. - „�' i ' .'_i._ CONNECTION DATA
�' -. = --' ems' ��"}•"�yl � STATION DEPTH
-CI-y. ? -7 TEL NO. _ a.'.° Y3z _-.__.._
_
L.J..:.wSATE... UPPER .
P.EG:STR A7iON N0 MANHOLE REFERENCE
COUNTY
NO. i GESC:RIATION OF WORK FEE YYYE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO I Y ,CUR P L M.L TO P.L. "
I
P48LIt SEWS $5,OD
SEPTIC TANK SEEPAGE PIT OR °� 9� JOB NO
PITS AND OR DRAINF;C.1.D @ $10.00 'p_R
HOUSESEWER CO-NNECTING TO I TRUNK PERMIT NO. ROAD PERMIT NO. ce
R14ATE DISPOSAL SYSTEM @ $3.00
CON NE.CT ADDI IONAL BL'OE OR -- AFFIDAVI( -W AfYER Eg5£MrN Y RECDRD IFeSTR 'vO` DATE };...
WORK TO HO JSE SEWER
OVERFLOW SEFPAG IT DRA N FIELD � '� Y � } __5 w
4
EXTN,CES ST'OOL.C7RYW EL L.MANHOLE C - -- - .__.-_�. .L...' -___ yt
$5.00 i - _._..
-. -
j_ _ 7____.__.-I__---__ HWY. OR ST.WIDENING tom'
'. AL LP.R PA:R OR ABANDON HOUSE
__ -_
FEWER ORD OSA SYSTEM
--_.. _-. STATE ENCROACHMENT
PERMIT'NO.
I
INDUSTRIAL
WASTE APPROVAL
_.__.. .__..__-- CHARGES
OWNRR75 PERMIT 5 z 00
AUTHORIZATION }DOTAL FEE CONNECTION CHARGE FEE
-I HAVE A'r THIS iJATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
7R7AC: :JR TO CG 'v E'T TIi E ABOVE UESC R!BED EXISY tNG OW SEEING .--_-_ _ _-_____
TO THE PUBLIC _EWEFR' APPROVALS DATE �NSPECYOR 5 SIGNATURE
)WNE.P,OR NEW HOUSE SEWER
O Vx'N E:NS AGENT _ CONN Ef:TAUDiT10NAL i
BUILDING 0 P V,'•;,N'K:
ADDRESS.._.-__
SEPTIC DRAT SEEP,PtT tSD
T ,E HAVE READ THIS APPLICATION`COMPLY
AND,OR DRAi_NFIY.LDAND STATE STAT£ HA 7F" A}3.OVE IS COPRF4T AND AL:REE TO I
H RFBY AtK OWLEDCL 7h1AI -_—_--- - __ ---�
WITH
-4LL COJ1 -Y ORD
IN:0.N�TE5 ANO S"i'ATE. L.A WS REGULATING ?-- -_---
PLUMB!NG AND -EWERS CESSPOOL Lr] DRYWELL
'1 HERIF.e- CEP-7'FY THAT F AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
j_i
CF
N- AS R.:QUIRED BY LOS ANG).ES CC?.kP..TY AND STATE OF SEWAGE DISPOSAL SYSTEM
AL. FORMA OR "HAT I A@C-"t LE AX OWNLkj OF, AND INTEND TO
DISCONP CCT PLUG AND
RE51OE .N, T'HE ABf�V EE R£SCrd'8 D ATEy;DEtLl VIAL PROPERTY. ARAN D0.1 Fi0U5E SE1ti ER
z _ _
SIGNATURE RE 'p r 3.' .'f- 1 _+".... BAC IIFILL P,IC TANKS__
OP Pf:RMtgTEE _ r _ L,,r�_ .�- I�
...� ..EER.PIY(.zi ❑ CESSPOOLS
f' VALIDATION ROBERT A. WOOD
SUPERVISING MECHA:WCAL ENGINEER
CK.. M.O. CASH