HomeMy Public PortalAbout9859 OLIVE ST_Sewer__ 16A
E-66�tl•ss APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL y
Department of County Engineer
County of Loa Angeles BUILDING
JOHN A. LAMSCE, COUNTY ENGINEER —ADDRESS
CASSATT 0. GRIFFIN, SUPT of BUILDING LOCALITY �a
FOB. APPLICANT TO FI4LL IN CROSS ST.
DESCRIPTION LOT NO y' OWN �✓` y,l
BLOCK TRACT r.•,',�, �yy �' ',, ' MAIL
' +'-. �+y ,�57
NO.OF BLDG S,'' 'r/—
CITY - '� TEL. N0._ '-
SIZE OF LOT NOW ON LOT
USE OF
DISTRICT N0. iT GROUP MAP
BK PG
CONTRACTORT
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ADDRESS CONNECTION DATA
", '� ,4✓ , �, &O l7, -- -----
STATtON �``' DEPTH _
CITY 7E1<. NO. - -
MANHOLE REFERENCE __ UPPER
TfiS7A7E 'LOWER
.REGISTRATION N0. � C COUNTY : BR,+' y�--^� .,— "y —49
No. C3ESCRlPTlON OF WORK FEE --,
--------- ------ TYPE OF CONNECTIfTN LENGTH FROM
HOUSE SEWEF2 CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER `a! $3.501,
0 I
Y. — ---
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELE (a $3.00
OVERFLOW SEEPAGE PIT DRAINFIELD I P. C. N0. .
EXTN_CESSPOOL,DRYWELL,M AN HOLE tai $2.001 CO. IMP N0. TOB NO,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM (i $I,QO I _ _-- TRUNK PERMIT NO. ROAD PERMIT NO. .
CONNECT ADDITIONAL BLDG OR --- --- — --_--
r STATE ENCROACHMENT
WORK TO HOUSE SEWER Cc+' $I.00 � _ PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE I I INDUSTRIAL
SEWER DL Ytd ttl
--__I_ R.__ODISPOSAL SSTE
_. ..__--- —_._---_—_-- ._.$.1.00 i a 'HASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
--
O` 3NEII°S PERMIT - - - - -�-. - --- -
_-- _-..-______��— __-•� 00 REI.MBURSEMF.NT FEE
AUTHORIZATION TOTAL FEE r
APPROVALS DATE NSPECI'OR'S SIGNATURE
I HAVE AT THIS GATE ACON7P.RCT Wi7H THE HEREIN NAMED CON- ____ ________—___.._..—s.--.-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PIUBLIC SEiVER. NEW HOUSE SEWER
SIGNED THIS----.—DAY OF_. __ .l9CONNECT ADDITIONAL
OWNER OR ro - d, BUILDING OR P ORh � -
Ou,'NERS ADEN - I
SNPTIC TANK,5F P PMS1
(51
ADORE •s _.Y",,,e' ✓ .. r AND/.OR DR,AiNFIELD _
AID EPEB THAT HE I)CEABOT A I HAVE
.. _T
1 HEREBY g1,tN VLEDCn THAT I. HAVE Rf AD THIS A LIGATION
CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL V
WITH ALL GOUNIY ORDIiINANCES — ------- _..-----._____
AND STATE l:A`:VS REGULATING ALTER,REPAIR.SEWER OR
PLUNBLIG AND SEWERS. SEWAGE DISPOSAL SYSTEM
i `• rtwTSY CERTIFY THAT I AM PROPERLY REGISTERED AND;OR DISCONNECT'PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF I
CALIF R IA Oil 1 HAT i AI+V/_tHl. LEGAL OWNER 0-F THE ABOVE - ""ANDON HOUSE SEYJfR ;
DESCRIBED RES.DENTIAL.P E.RTY. BACKFILL
BACY.FI LL SFt TIC TANKS-❑ + _
SEEP. PI1 TSj_�] CE`SPOOLS I;. I.
SIGNATURE ' .. -
OF PERM1TTE£— i -
-—
mi
JOHN A. LAMBIE, COU ENGINEER ff- ACID TION ROBERT A. WOOD, CHIEF PLBG, INSPECTOR
N. 0. CASH
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