HomeMy Public PortalAbout9869 OLIVE ST_Sewer__ E808 n
: APPLICATION FOR PERMIT 7
`x808 s.sit COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL ,1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDIADDRESNG
JOAN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup't of Building LOCALITY ti
FOR APPLICANT TO FILL IN _CEAs NEAR}aT
LEGAL Pc
DESCRIPTION LOT N0. ' OWNER - .,
BLOCK TRACTMAIL
�p'a: ,�� _. •'�'` �- F ;_ADDRESS
F NO.OF BLDGS �'
SIZE OF LOT S 0 NOW ON LOT CITY TEL, NO,
USE OF a +
BUILDINGS ue+ R' s- ! "c v DISTRICT N0. GROUP MAP PROCESSED BY:, j
BK PG
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CONTRACTOR ✓ �,
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ADDRESS _ CONNECTION DATA
CITY s" TEL,NO. it STATION DEPTH
Ur-IrTATE MANHOLE REFERENCE UPPER
REGISTRATION NO. y 'd 0 COUNTY
LOFVER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER C- $9.00 TYPE OF CONNECTION LENGTH,FROM
EXTN_
EPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
_+
ITS AND/OR DRAINFIELD { $3.00 -
VERFLOW SEEPAGE PCT,DRAINFIELD
CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO, JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMITNO. ROAD PERMIT NO.
WORK TO HOUSE SEWER C� $1.00 _
ALTER;R�A+R4 3'F-�'rRA-NDiak HOUSE t - STATE ENCROACHMENT
SEWEROP'.ISP^.,.S,`I .SYSTEM Cd) $1.00 - _PdR61?'f IV O.
INDUSTRIAL
WASTE APPROVAL
��,t�rc�
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE 14EREINAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE:
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF _19__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK.,SEEP.PITS)
_AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER nEPt>X;SEWER OR
PLUMBING AND SEWERS. ALTER, OISPQ$SEWEROR _
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE
1)15T 0LALSYS
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
ISCONABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS []
SIGNATURE . _.
SEEP.PIT(S) [� CESSPOOLS
OF PERMITYEE -
�r VALIDATION ROBERT A. WOOD
Cx..a U.0. CA.5.FI SUPERVISING MECHANICAL. ENGINEER
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