HomeMy Public PortalAbout10065 OLIVE ST_Sewer__ P6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 'BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building LOCALITY
FOR APPLICANT TO FELL IN
LEGAL T NO. OWNER R
BLOCK Al,ifR MAIL
ADDRESS
NO.OF BLDGS,
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OF I
BUILDINGS r DISTRICT NO. GROUP
d GR UP MAP PROCESSED 91Y
OUP BK PG
CONTRACTOR A ,� Aly i)
/u/- 4
ADDRESSCONNECTION DATA
_-f'?�/ALL
CITY TEL.40. STATION DEPTH
STATE MANHOLE REFE UPPER
REGISTRATION NO. l COUNTY L
N0. 1 DESCRIPTION OF WORK_ FEE
- , . i I
HOUSE SEWER --.r -=c;t,
PUBLIC SEWERCONNECTING TO @ $6.00 - ,
TYPE OF CONNECTION LENGTH FROM
PITS AND
SEPTIC TA/NK,SEEPAFGELPID T OR $1.00 Y. CURB P,L. WL.TO P.L.
OR DRAINIE0
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $1.00-- 0-
HOUSE SEWEPNNCCTING TO 0
DISPOSAL
PRIVATE DI ,AL SYSTEM @ S1100 Co.lmp,NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD-PiRMIT NO, eY
WORK TO HOUSE SEWER P S400
REPAIR OR ABANDON 0
ALTER ON HOUSE STATE ENCROACHMENT
DISPOSAL
L 9 PERMIT NO.
SEWER A SYSTEM @ $100
INDUSTRIAL % 91.Uj
WASTE_APP.OV-Al
CHARI S
OWNER'S PERMIT 2 00 CONNECTION CHARGE FEE lk\--1
AUTHORIZATIONTOTALFEE 71 i 3 REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACY WITH THE HEREIN NAMED CON- APPROVALS
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING-DWELLLNG DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THISDAY OF 19- NEW HOUSE SEWER
OWNER OR l CONNECT ADDITIONAL
OWNERSAGENT- BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL LD DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER-REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM___
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT F/A ')THE LEGAL BIER OF THE ABOVE -
P 0 BACKFILL L 5 E P T 13C CESSPOOLS S 0
RESIDENTIAL P O#ERTY� SEEP.PIT(S) POOLS
OF PERMiTTE SIGNATURE
VALIDATION ROBERT A. WOOD
CK, M.0. CASH SUPERVISING MECHANICAL ENGINEER
CE848 3 12
APPLICATION. FOR PERMIT
75A842D
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING .y
JOHN A. LA,MBIE, County Engineer ADDRE 5
WILLIAM A. JENSEN, Supt ®i Building LOCALITY
[IN?-A,05R 5 FST
t
FOR APPLICANT TO FILL IN -- --
LFGAL --
r
0 F 5C RPT iCi^t LdT NO OWNER
:AA;L
BLOCK TRACT ADCRESS
NO. OF SLDGS.
SITE OF LOT
NOW ON LOT _ - CITY TEL, NO.
USE OF /
SUIDINGS -.ter..= - DISTRICT N9. GROUP MAP PROt,EBBED SY
PG
BK
CONTRACTOR
AaDREas � ��2 `L c m r. '> a.a ✓„ -- CONNECTION DATA -- — --
- - --
. 571TION -' DEPTH. _
CITY ,-L._¢I '� `r➢. tr i.� TEL N -_ �$:- � i
•-.. i6y r !
STATE UPPER
MAfdHO E REFERENCE sC#'ArER
REGISTRATION NCl ,gr"� �'J L) COV NTY
_—
ya. DESCRIPTION OF WORK EE .o dL TtO7d LENGTH FROM
TYPE O
HOUSE SEW"R CONNECTING TO �— Y. CURS P M.L. O F.L.
PUBLIC SEWER C¢ 35_44
FSEPTIC';TANK.SEEPAGE PIT OR _— .. -- t. -_._ - - _..
PIT AND/OR DRAINPIELD.. Q $IO.Otl CR fihK PERMIT
NO --_—_.__._
.MP NO,
PRIVATE
SEWER SAL NEC TANG O T NO �µROAD PERMIT NO.
PRIVATc`D:SPO$Ai SYSTEM $3.CY4
—
CONNECT i ADDITIONAL BLDG :OR AFIDAVIT waives( an-F:NEH3 RECORD.rN5 H NO. j DATE
WORK
RK TO HOUSE SEWER,
OVEt2FLOW SE mPAGE PIT,t}RAINFiELD
c XTN,CESSPOOL.DRYWELL.MANHOLE @ $5-40 i t
—.____ _-_...___. _. HWY. OR ST.WIDENING
NL7ER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM - y:x.04 S'7'A 7E ENCROACHMENT
MET
__— PERMIT NO.
- �-- �- WASTE APPROVAL
dwR PERMIT 2 00 -- -- --- - — ---- -
--- - --
AUTHOPUATION TOTAL FEE
C)N NEC,T iCJN CHARGE FEE
'- HAVE A7 7i-fiS DATE .4 CCONTRACT WITH THE: HEREIN NAMED CON- REIMBURSEMENT FEE
-------------------
TRACTOR TO CONNECT IRE, ABOVE DESCRIBED EXISTING DWQ-L.INv -- --- -_. - �r--- - -- —i ---- -----
TO THE 8'UESLIC EWER APPROVALS ! DATE TINSPECTOR-S SIGNATURE
SIGNED THIS -.. DAY
OWNER OR NEW HOUSE E,V^/ER
OWNERS'AGENT _--'. - �----_ ___--- CON NFCTADDIT ONAL 1
BU.LDI dc,CIR WORD
ADDRESS —__ _- __. -____ _.-'_ ..___II--_._._— -
-..._ _. -_ -._. SEPT)(- TANK.SEEP,PiT(S) I
t HEREBY Ar KNOJe'.L EDGE THAT I HAVE RFAr, THIS APPLIc AT ON AND/UR D-RA;NFIELD
AND STATE THAT THE ABOVE IS COF RC ANO AGREE TO COMPLY
WIT i ALL COUNTY ORDINANC e5 AND STATE ;.AWS REGULATING
PLUMS)NG AND ,SEWERS. CESSPOOL `I GRYWELL LJ
1HEREBY C'c RT!FY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR
T:E''SEDAS REQUIRED BY LOS ANGLES COUNTY ANT.) STATE 'O7^ SEWAGE DISPOSAL SYSTEM
A:.I`E:E B
CNI.A. OR THAT :AM THE LEGAL O'dW iV F_R L AND !NTF_NG TO DISCONNECT- PLUG AND — ---
RESi IN. TSiE AyYi E 7L'iESCRI HEG R.81D£Nl'tAl PROPERTY- ABANDON HOUSE SE'W'ER
S[GNATURE ;4. ? i
OF PERM""E£ �gp. vJ�w> � BACKF LL SEP71c TANIiB
_� _-..._._—.-.._ SEEP„IT(s) ❑ cESSF'DOI S
VALIDATION ROBERT A. WOOD
i
CK. M.O. CASH SUPERVISING MECHANICAL ENGENEER
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