HomeMy Public PortalAbout9950 OLIVE ST_Sewer__ E808.8
CE@O$�8•58 APPLICATION FOR PERMIT - - - 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS _ s
CASSATT D. GRIFFIN. Supt of Building LOCALITYMEARES
CROSS 33:::/
FOR APPLICANT TO FILL IN
LEGAL J A
DESCRIPTION LOT N0. ,` �k' ' �s ° ' c" OWNER ' -,
BLOCK TRACT : MAIL
ADDRESS
NO.OF BLDGS. F''
SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE OF y
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
K PG
CONTRACTOR h $
ADDRESS CONNECTION DATA
CIT% y TEL.NO. , STATION= 4 DEPTH
_ f
STATE
REGISTRATION NO. + �: COUNTY MANHOLE REFERENCE PER
NO. DESCRIPTION OF WORK FEE ZL�, ' L WER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 .$3.00 � �'e�:��•
SEPTIC TANK,SEEPAGE PIT OR TYPE OF Cq)fNECYION LENGTH FROM _
PITS AND/OR DRAINFIELD 0 $3.00 Y ��CURB.;' P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
_EXTN.,CESS POOL,DRYWELL,MANHOLE 0 $2.00
[CONNECT
OUSE SEWER CONNECTING TO P.C.N0.
IVATL'DISPOSAL SYSTEM a $.1,00 CO.IMP..NO. �., JOB NO.
ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT NO.ORK TO ViOuSE SEWER C� $.I= c i7' �
ALTER,R£PAT t OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM Cyd $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PUMIT 3 1 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED TMS ,L f d)AY OF _: NEW HOUSE SEWER
OWNER OR .,` CONNECT ADDITIONAL
OWNERS AGENT -6 , BUILDING OR WORK
'- ..✓�, SEATIC TANK,SEEP, PIT(S)
ADDRESS :� ,y,e''�, g -:J:u',Y't"'.;,.,:. 'ND/OR DRAINFIELD -
I HEREBY AC<NOWLEDGE THAT I HAVE READ THIS APPLICATION }
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CwSSPOOL[] DRYWELL❑ I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 RESIDENT t,,PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT IS) [] CESSPOOLS ^�
OFP£RMITT}
r �---,VALIDATION ROBERT A.WOOD
R.0. CASlt SUPERYLgINGhii=Ct°IV+NLCAL,ENGINEER
«:� 6.0 v.