HomeMy Public PortalAbout10063 OLIVE ST_Sewer__ i
CEBO5 3-62
76.A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNE
ING
JOHN A. LAMBIE, County Engineer
ADDRESS �s � --- —�-----_ — —
WILLIAM A. IEN5EP, Sup`f of Building
ITY C.JJ '�`�s �A�
S57. y„ r�.�,1 9Lw- f i T
FOR APPLICANT TO FILL IN _ --
-LEGA - - -- -
- -- - y
DESCRIPTION -GT S^> OWNER „•' +W t F-# -.__
MAIL
BLOCK TR:..CT ADDRESS
NO OF SLOG'S.
SIZE OF O'"(_. _.__. NOVV_ON LtJ T..._ CITY TEL. NO.
t E OP
B_I D NGS � DISTRICT NC. GROUP MAP PROCk:SSED.BY
--. HK FG
_CONTRACT'OFd
ADDRESS ` I X_ ` b - � CONNECTION DATA ---
A �
a+' STATION DEPTH
TEL.CITI a.3.W'�^-"e_ v T N e • _,
STATE_. — --- UPPER
! MANHOLE REFERENCE -:: •-
REGISTRATION NC. � T �. � L � IJ4 COUNTY -' -.- LOWCR
NU. DESCRIPTION OF WORK FEF TYPE-OF'CONNECTION LENGTH FROM
s*
HOU ESIEWEiR CONN CTING Y CURES P:L.,- WL :O P L.
_
PUBLIC SEWER P.C.NO,
SEPTIC.TAN t,SEEPAGE PIT CIR j _._. U
CO.IMP.NO: J09 NO. ._,
.O n'SE Sk`A+fR CONNECTING O ...00
,':_.-.—.--
PITS ANQ/OR DRAINFIfLb �- $^R1 _ _
H C TRUNK PERMIT NO ` ROAD PERMIT NO. j
l PRIVATE DISPOSAL SYS EM @ $3.00 _ b
_. __
CONNECT ADDI ICNAL SLOG R � � AFFIDAVIT Lid Y[R EhSsHk NT I RECORD.iNSTai.NO. DATE ha
_ jWORK TO,HOU$iE EWER @ 53'..00 64,E
OVERFL.4aW SEEPAGE PFi.DR4lN FIELD
EXTN._,CESSPOOL DRYWELL MANHOLE
-__ _.O_ HWY.OR 'T.WIDENING
ALTER.REPAIR OR ABANQN H.OIiSE b"-'_00 I
i
EW:ROR Q15P0 AL SYSTEM .___-.._- _
_
X3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
j I WASTE APPROVAL.
CHARGES
OWNER'S PERMIT
AUTHORIZATION T0TAI- FEE ,�y INNFC710ta CNARCF FE
bd
HAVE AY -i H,5 DATE A CONTRACT WITH THE HEREIN NAMED CON-- �2EI F1BUR5EMEPdT FEE
T-,RA TOR TO i T`f P-E'CT 'THE ABOVE DESCRIBED EXISTING DWELLING --_- —�p.p+,�7
__O RHE "U EIL1. SEINER. APPROVAL I DATE N9PEC.'6"CI355IG NATa:IftE
SiG IED T'H9S_ _DAY O ----
OVdNEP OR � ) y�Fy� J._ NEW HOUSE SEWER
OW NEA A<'ENT__._.__..—_L� Vii.—..__
--- CONNECT ADDITIONAL .
BUILDING OR WORK
SEi"1-fC TANK-S&}F PIT(S) I
I . ERE$ .ACKNOWLEDOF THAT I HAVE RVAD THIS APPLICATION AND/OR DRAF.iNI::_D
AND STATE THAT THE ABOVE i5 i3ORRECT-- AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I
PL,'J MB.NG P.ND SEWERS, CESSPOOL- 0 DRY"WELL
I 7"'RF_BY CERTIFY THAT t AM PROPERLY REGISTERED ANG/OR AL7E.R,REPAIR,SEWER OR j.
LICENSED AS REQUIRED BY 3.05 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL.IFORNiA OR THAT 4M THE LEGAL OWNER OF AND INTEND 70 DISCONNECT
PLUG AND
RESIDE IN, TH_. ABOV '7 CRiBED R[SI EN •AL PROPERTY.P ABANDON HOUSE
£WER
SIGNATURE 6 ` _... —._—
OF PERMk T'TEE_-�_ j _�.V _ _ _ tld'� —____ _____ BACKFILL SEPT it.TAN1C5 [�
__ SEEP,PIT(S) CF';55-PObI.S
IIVALIDATION ROBERT A. WOOD
CK. M.O. CASH W(�
sSim N. b1
GG ECHANICAL EENGINEER'.
f;
:6 81
'6A6420642D APPLICAT 06N FOR PERMIT
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION aU'R IEESSNG
JOHN A, LAMB:IE,County Enginsex h
'WILLIAM A. JENSEN,Supt u!Scalding
LOCALITY
NEAREST
F"OR APP CANT TO FZI.I. _ _ CROSS ST.
LEGAL - � ,a - -�
DESCRIPTION LOT N0, OWNER .
BLOCK TRACT - e' MAIL
' .. r '_-?t ADDRESS
140.OF BLDGS:
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR P{ 1
f_
ADDRESS CONNECTION DAA
CITY't .Y` TEL N0�— l r L <�� h" STATION °" DEPTH
c, STATE MANHOLE REFERENCE
REGISTRATION NO. / ( \` `� COUNTY LOWER
NO. DESC N QF WORK FEE
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER $ °,00 c
OF CONNECTION LENGTH FROM
Y.SEPTIC TANK,SEEPAGE PIT OR `. TYPE CURB P.L. M.L.TO P.L.
.
PITS AND/OR DRAINFIELD S .00
OVERFLOW SEEPAGE PIT,DRAINFIELD }
EKTN„CESSPOOL.DRYWELL @ S .00 p,
HOUSE SEWER CONNECTING TO - -' ' P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $.00 Co.IMP. NO- JOB N0.
WORK TO HOUSE SEWER
OR $100 TRUNK PERMIT NO. ROAD PERMIT NO.
SEWER REPAIR
�SAL ST£N HOUSE C-b $ 00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL C
EtA
CHARGES z
OwNws PERMtT $ 2 QQ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT TRACTOR TO THIS
THE ABOVE DESCRIBED EXISTING DWNAMEELLONG APPROVALS DATE tNSPECTOR°S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS - DAY OF-, '9____ NEW HOUSE SEWER
OWNER OR OR - CONNECT ADDITIONAL
OWNERS AGENT--i,.,- ` BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL 5YSTE
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND r0
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 RESIDENTIAL-�$OPERTY, BACKFILL SEPTIC TANKS
SIGNATURE �,"; -
SEEP.PITS s l CESSPOOLS
OF PERMITTEE l Vl—-:
`VALIDATION ROBERT A. WOOD
CK.1 a,0. CASH SUPERVISING MECHANICAL ENGINEER