HomeMy Public PortalAbout9863 OLIVE ST_Sewer__ E808
8' .58 APPLICATION FOR PERMIT-
: 8
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
IOiiN A. I AMBLE, ?*—I r E,,,n-o r ADDRESS d Lv
CASSAI'T D. GRIFFIfI. Sup t of Bu,Ig g LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL " ry OWNER
DESCRIPTION LOT NO. P A r.r,
BLOCK TRACT MAIL
ADDRESS
NO.OF
SITE OF LOT ' S +� NOW ON LOTS ate— CITY TEL. NO,
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY ,
BK PG i
CONTRACT
ADDRESS CONNECTION DATA
CITY TEL.NO. _STATION ' DEPTH
,�''''�TATE MANHOLE REFERENCE
REGISTRATION N0. 6 ... ."� L,J COUNTY
r' LOWER.>
,,�N0, _ DESCRIPTION OF WORK FEE
�"""HOUSE SEDER CONNECT NG TO -
PUBLIC SEW xR @ $3.00I r
--�+'— 7YPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. .'eyRB;> P.L. M.L.TO P.L,
PITS AND/OR DRAINFIELD @ $3.00 —
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE:SEWER CONNECTING TOP.C.140.
VA
PRITE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. d JOB N0.
CONNECT ADDITIONAL BLDG.OR j -
+' WORK TO HOUSE SEWER $1,00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $f.00 PERMIT NO.
:NDUSTRiAL .
WASTE APPROVAL
_ CHARGES
O I'S ftRMIT $ 2 Or 0 CONNECTION CHARGE FEE
AUTH0RIZATION TOTAL FEE —I ;r' REIMBURSEMENT FEE "
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE (INSPECTOR'S S!GNAT'URE
TO THE PUBLIC SEWER.
SIGNED THIS DAY ONEW HOUSE SEWER
OWNER OR
OWNERS AGENT a� �"v� CONNECT OR WORK O
— BUILDING R WORK _
ADDRESS SEPTIC TANK,SEEP.PIT(5)
- - — AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO C014PLY CESSPOOL 0 DRYWELL CI
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE. OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. ABANDON
L SEPTIC TANKS ❑
SEEP.PITS) 0 CESSPOOLS
SIGNATURE jp��``-� ��++''�� �3 �. -
OF PERMITTE5_._..I?���1r.�r_.__
-VALIDATION ROBERT A. WOOD
� CKyI' M.U. CASH SUPERVISING MECHANICAL. ENGINEER