HomeMy Public PortalAbout10023 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING y a° F" ("_r' NEARESTADDRESS NEAREST
- d s' ,/ d GROSS ST.
LOCALITY I`� r DISTRICT NO. SERIAL NO. PERMIT NO.
3 bf A _ S
NEAREST �� t )
CROSS ST. ,
s - RECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL
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CITY C TEL.NO. ?
CONTRACTOR °} _ -✓ $�O.IMP.NO.
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CITY ° TELAO. TRUNKPERMIT N0. .°
REGISTRATION NO. j STATE
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
--- — -- -- PERMIT NO.
BLOCK TRACT INDUSTRIAL
— ------- WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF r
BUILDINGSr CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
'
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 , RECEIPT NO. I DATE f BY
PU f
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING ! NO- DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 i CONNECTION DATA
SEPTIC TANK 8E£PA6E P17 OR
—,-"E
PITS AND/OR DRAINFIELD 2.00 f STATION DEPTH
CESSPOOL—DRYWELL -=3
SPECIAL CONDITIONS ONLY 2.00 f MANHOLF REFERENCE
UPPER "S:t wblR
TYPE OF CONNECTION — LENGTH FROM
Y. CURB
OWNERS PERMIT $ I 1 00 P.L. .i M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I -
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS........___...__DAY OF.. :-. I9��.:, NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS------- ..-- ------ ... ........ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL1- CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
RHD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BAGKFILLSEPTIC TANKS
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SIGNATURE
SEEP.PIT(S)o CESSPOOLS G+
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OF PERM ITTEh r,> ._..,_ ---- -------'`,
7GA642D 663 1/53