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HomeMy Public PortalAbout10051 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL DIVISION OF 'BUILDING AND SAFETY , r PERMIT APPLICATION_ COUNTY OF LOS ANGELES WILLIAM J. FOX. COUNTY ENGINEER _ ;I-ADD RESS FOR APPLICANT TO FILL IN - LOCALITY BUILDIN EST ADDRESS CROSS ST. rL N LOCALITY DISTRICT NO. SERIAL N0. PERMIT NO. CROSS ST . /�.�,% Lrs� f S p yy�� REC,E�JJYE�D/BJ�Y,, _ Ready tdr Inapeotion DATE ISSUED_ C OWNER .Ir�IQen 'V(Y!/�U�ry, MAILADDRESS �r ? USE ZONE OCCUPANCY MAP CITY // TELNO. f-i V/ �///� BK 2.� CONTRACTOR' ��✓.. .rnsl .�.�P"�° ! .i CO.IMP.NO. ADDRESS. X rl pf ', JOB.NO. ' � EL'.NO. �'�' TRUNK PERMIT NO. STATE. REGISTRATION NO. •' COUNTY, ROAD PERMIT NO.LEGAL ' DESCRIPTION, LOT N0. d"95 r, , 1 ®°�,t",,e 3� STATE ENCROACHMENT ' PERMIT NO. `BLOCK TRACT �� INDUSTRIAL \ WASTE APPROVAL ) SIZE OF LOT NO.OF BLOCS. C)dARGES NOW ON LOT USEBUDI INGS A CONNECTION CHARGE:FEE NO. DESCRIPTION OF WORK FEE i REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO ,�✓• PUBLICSEWER op s 3.50 0e® RECEIPT NO. - • I DATE I BY. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR "EXCEPT)'ON RECORDED WORK TO HOUSE SEWER I.00 tJO? N0. ALTER OR REPAIR EXISTING I DATE -,BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER' AND/OR DISPOSAL SYSTEM 1.00 -CONNECTION DATA- - PITS AND%ORDRAINFIIELDT OR 2,00 STATION DEPTH j CESSPOOL-=-DRYWELL SPECIAL CONDITIONS ONLY 2.00 �t76~ MANHLEER EFERENCE�-• i �`� LOWER TYPE OF CONNECTION �` LENGTH FRO�hY-3 J OWNERS PERMIT $ GlUUL P.L. M.L.TO P.L._ Y ' _-_Io 1JX Y // � ', . 1lv AUTHORIZATION TOTAL FEE / CS _ �' �/j� I HAVE THIS DATE.CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING' APPROVALS INSPECTOR%SIG'NATURE DATE DWELLING TO THE PUBLIC SEWER� •.��-- i SIGNED THIS_.__.._.__DAY OF_SPa�iegigs� I NEW HOUSE SEWER OWNER: OR CONNECT ADDITIONAL OWNERS N ..... .--+. _.��.�.�c !®,� �, BUILDING OR WORK AGE , - 3 / SEPTIC TANK,SEEP.PI-T(S) AADDRESS*.: �e�.e [��.� !r �_-tom_ __ ..__..__ �i AND/OR DRAINFIELD 1. HEREBY ACKNOWLEDGE THAT-1-HAVE READ THIS APPLI-: CESSPOOL'[] ORYWELL"0 ` CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TOCOMPLY WITH ALL COUNTY ORDINANCES AND.STATE LAWS: PETER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE-DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED' DISCONNECT.PLUG'AND - AND/OR LICENSED AS REQUIRED BY LOS ANGELES'COUNTY: DISCON NHOUSESEWER AND STATE OF CALIFORNIA OR THAT I AM-THE LEGAL OWN-, ER OF THE.ABOVE DESCRIBED RES TIAL PROPERTY. BACKFILL SEPTIC,TANKS©i SIGNATURE SEEP.PIT(S)E] CESSPOOLS O OF PERMITTEE.. 76A642A 669 7/53 Eos _ �� �}��� 77A