HomeMy Public PortalAbout10529 OLIVE ST_Sewer_9/28/1964_ : A642D 63
6A642D APPLICATION FOR PERMIT g�
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDIN f) 0
C1 C
JOHN A. LAMBIE, County Engineer ADORES L ply J
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST jam' Al 43 /.,
FOR APPLICANT TO FILL IN CROSS BT. ,�
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT 7 49 / 1.1 ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO. GROUP MAP PROC ED BY
BUILDINGS
C BK PG
CONTRACTOR 4 - .� t'1,.-�✓ _ l 7/'
(7 V CONNECTION DATA
ADDRESS ammm,, �Ly.-y� /�, /�
CITY /(3,_ . NO. Z V 6 6 J ST N/ DEPTH
STATE PER
REGISTRATION NO. ( Q Ll COUNTY MANHOLE REFERENCE 'Jy
NO. DESCRIPTIO"N OF WORK FEE TYPE OF CTION r LGTH FROM
HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. S
I PUBLIC SEWER @ $5.00
SEPTIC TANK,SEEPAGE PIT OR P.C.NO. O
CO. IMP. NO. JOB NO. V
PITS AND/OR DRAINFIELD @ S10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT
PRIVATE DISPOSAL SYSTEM @ $3.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER E15EMENT RECORD, INSTR.NO. DATE
WORK TO HOUSE SEWER @ S3.00 W
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL.MAN HOLE @ $5.00 d
h
y
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.W ENING y
SEWER OR DISPOSAL SYSTEM @ S3.00 STATE NCRO HMEN / 4
PERMIT / /go
INDUSTR AL
WASTE APPROVAL
CHARGES
OWNERS PERMIT E 2 00
AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
LANDA
TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
HE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
ED THIS DAY QF 19_
R OR fi. . I NEW HOUSE SEWER
ERS AGENT 4 V�( CONNECT ADDITIONAL
BUILDING OR WORK
ESS SEPTIC TANK,SEEP.PIT(S)
EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
BING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
EREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
SED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
ORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG ANDE IN, THE ABOVE DESCRIBED RE IDENTIAL PROPERTY. ABANDON HOUSE SEWER
ATURE BACKFILL SEPTIC TANKS ❑PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑
�CK M.O. CASH ALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
2 7 9:S SEP 2 8 1 0 D 7.0 0„