HomeMy Public PortalAbout9857 OLIVE ST_Sewer__ 76AG42Dr.6d-663 t2=55
& APPLICATION FOR PERMIT
3
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D, GRIFFIN, SUP'T OF BUILDING: LOCALITY ;,- -
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL �------ �-,- ---
DESCRIPTION_ LOT NO. � _d1 OWNER )
BLOCK TRACT,?,. /� �,, yam` MAIL
ADDRESS
V NO.OF BLDGS. �f
SIZE 019i- _ NOW ON LOT CITY r TEL. NO
USE OF - --_---
BUILDINGS DISTRICT NO. GROUP MAP
CONTRACTOR / _
----t;"�t"_'."_i-ria--e --" -- '—
ADDRESS _ CONNECTION DATA
CITY TEL. NO. —� _ STAT'dON �� 'mss DEPTH
—+ _-tet---� ° '�` _ MANHOLE REFERENCE --- - UPPER .
[] STATE _-- _ �_---- LOWER
REGISTRATION NO. COUNTY _
No. -DEsCki-Ff-16K of ur0RK FEE --
TYPE OF CONNECTION LENGTH FROM
--�-� HOUSE SEWER CONNECTING TO--4--- �---- Y. CURB- P.L. -M.L.TO P,L.
PUBLIC SEWER__ @ $".50-1
--- ---- -- -_—
-- SEPTtCTANK,SEEPAGEPl7 OR-------- — -
PITS AND/OP DRAINFIEL,D (U4-$3.00 ___ ---------- - .—_
OVERFL64S`SEEPAGE PIT,DRAINFIELD I P. C, NO.
EXTN.,CESSP,�+OL,DKYWELL,MANIiOLE Ca? $2,001 CO IMP. NO. 10B NO. _
_._.
' ROUSE SEWER CONNECTING FO
,_PRIVATE DISPOSAL SYSTEMONEGF. $I.DO � TRUNIK PERMIT NO. ROAD PERMIT NO.
CONNECT
ADDITIONAL BLDG.OR STATE ENCROACHMENT - -
j WORK TO HOUSE SEWER Gt $1_00 ; PERMIT NO,
—�
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEV ER OR DISPOSAL SYSTEM a $i.03 WASTE APPROVAL
CHARGES
CONNECTION CHARGE
OWNER`S PERMT i I�{ oo -_ _— -- ---
AUTHORIZATION TOTAL FEE
REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON= .-_- APPROVALS _ _, i, ..DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECF THE ABOVE DESCRIBED EXISTING DWELLING I
TO THE PUBLIC SE'XER. NEW HOUSE SEWER
SIGNED THIS_ _DAY OF_ Ig
CONNECT ADDITIONAL
OWNER OR �`�� B.UILDING OR WORK—_
OWNERS AGEN -L�i SEPTIC TANK,SEEP PITS} — -- ------
rr ANDlUR DRA.INFICLD _
-ADDRESS
-I HFP PY ACKt LE E THAT i HAVE, READ THIS APPLICATt CESSPOOL DRYWELL El I
AND STATE THAI THE ABOVE IS. CORRECT AND AGREE TO COR LY
I HFALL COUNTY
CERTIFY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEVIER OR
—.'-- -PLUMBING AND SE SEWAGE DISPOSAL SYSTEM !
LiICEtiSAD'ASORE REQUIRED I AM PROPERLY REGISTERED AND/OR --- --- --- --a----�i—`- ---
LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR 'HAT [ 7 THE LEG OWNER OF THE As0`v`E ABANDON HOUSE SEWER
DESCRIBED RES:DENTIAI .UPER7:1'. .BACKFILL SEPTIC TANKS f1 �----��--�— -^----
' SEEP. PIT(S) I 1 .. 5SPOOLS I
SIGNATURE d: --- _ ._— .—. .--+-------*'—_--' ------..
OF PERMIT7E i
JOHN A, LA;MBIE. 96LINTY ENGINEER .,VALIDATION ROBERT A. WOOD, CHIEF PL13G. INSPECTOR
CASH