HomeMy Public PortalAbout9915 OLIVE ST_Sewer__ 1'
3a Ea- 63 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING ^
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
3'J CASSATT D.GRIFFIN, SUP•TOF BUILDING LOCALITY
7�i£AR.EST
FOR APPLICANT TO_..FI. r, s cRYoss sTo t` 'ir
LEGAL — �- - ,.-. OWNER _
DESCRIPTION LOT NO
MAIL
BLOCK TRACT '� d,: - 6&0....!-.._ ADDRESS-__ - L/ -+ tl:b=-t�"1
N0. OF BLDGS. r11 p
SIZE OF LOT NOW ON LOT / CITY, ---^" TEL. NO,
USE OF --- - _-y- DISTRICT NO. GROUP MAP
__BUILDINGS _ _
„y BK PG
CONTRACTOR
ADDRESS CONNECTION DATA ---------
---- — �- ` — s"
f f ,+, _" STATION - r, DEPTH
CITYM, �'"n TEL. N0. '---- - -
--- —"-- -- _ -- MANHOLE'REFERENCE OFFER
,.- JU--STATE - LOWER
0 COUNTY
REGISTRATION N0. zf r",, _ ,.> ----- --
No. 1 DESCRIPTION OF WORK FEE ----- -- - --- -------
----- USES- ------ ---
HOUSE 5>:+/ER.CONNECTING TO i
_�..i PUBLiCS VE2 @ $3,50 z_ Y• TYPE OF CONNECTION LENGTH FROM
CUP.B P L. M,L.TO P.L,
SEPTIC TANK,SEEPAGE PIT OR -
j PITS ANO OR DRAINFIELD rt $3.00
OVERFLOW SEEPAGE PIT DRAINFIELD I � - _. P. C. NO.
EYTN-CESSPOOL,DRYW ELL,MAN HO LE (tl $3,001 CO. IMP. N0. JOB NO.
HOUSE SEWER CONNECTING70
PRIVATE DISPOSAL YSTE.M �u` $1.00 I L TRUNK PERMIT NO. ROAD PERMIT
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
j WORK TO HOUSE SEWER (ii $1.00 ! PERMIT N_0.__
-- ._... .—� --- ---_._._.
1 ALTER,REPAIR OR ABANDON HOUSE -
-----------------
SEWER OR DISPOSAL SYSTEM �z $I.CO INDUSTRI.RL
r_ _--- _ WASTE APPROVAL
CHARGES
CO. ddLCl 10N CHARGE FEE -
OWNER'S PERMIT 1 00
- '-'-If--- �;--- REIMBURSEMENT FEE
AUTHORIZATION 1 TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE �INSPECT<;R_SSIGNAI'URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -
TO THE PUBLIC NEW HOUSE SEWER �
SIGNED THIS--.- ,, DAY OF_ 19—_ CONNECT ADDITIONAL --
OWNER OR BUILDINGOR.WORK
J+'
ONERS AGE
SEPTIC TANK,SEEP,PIT(S)
. "'� ' + w •' tJt':r-1 AND/OR DRAINF1ELO
I HEREBY ACKNCWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAI THE ABOVE IS CORRECT AND AGREE TO COMPLY
11 TF{ ALL COUNTY ORDINANCES AND STATE LAWS RECULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS.
SEWAGE DISPOSAL SYSTEM i
I HEREBY CERTIFY THAT 1 .AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSLD A5 REOU;RED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
HGPLUGASE
CALIFORNIA OR THAT i AM THE LECAL OWNER OF THE ABOVE ABANDON- --- SEWER- - -- - --
DESCRIBED RESIDrNTIAI,, O.F.ERTY. �^;5 _ BACKFILLSEPTIC TANKS`]
SEEP. P11(S) i,] CESSPOOLS OOLS ]
SIGNATURE `.
OF PERMITT£ - i I "--
JOHN A.LAMBIE, CcwdNTY ENGINEER ALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
tH.0 CASH
iHt ,p