HomeMy Public PortalAbout10067 OLIVE ST_Sewer__ v ,
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842a�a 0�, APPLICATIONFOR PERMIT
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COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 3
JOHN A. 1AMBIE, Cav�tT En neer ADDRESS �
WILLIAMA. JEIdSEIQ, �;p`i of ailding 6 P i
LOCALITY _
NEAREST
FOR APPLICANT' TO FML IN CROSS ST, �4
DESCRIPTION 'LOT MO b ,. .1`� �„�-�T`" y,.../ OWNED :�� ,�..�r�. r',5)....�'
BLOCK TRACT� [ " MAIL
`/,k ' 4 P�4 t ADDRESS
51 19O<OF BLDGS,
SIZE OF LOT NOW ON LOT CITY TEL 0
USE OF
BUILDINGS DISTRICT NO. GROUP MAP P CESSEDBY
OK PG
CONTRACTOR
A r.
ADDRESS i_:i
- CONNECTION DATA
CITY , Z a ,_ f `TEL NO.,,_. STATION i o DEPTHS
�( STATE MANHOLE REFERENCE r 1 UPPER
REGISTRATION NO. ? COUNTY ,
NO. Di SCRIP`if-N OF R ���
HOUSE SEWER CONNECnNG TO
PUBLIC SFWECI T OF N ION LENGTH FROM
SEPTIC TANK,SEEPAGE Ply'OR Y. P,L, M,L>f0 P.L.
l
PITS AND/OR DRASNFIELD (a s ,OO `.
OVERFLOW SEEPAGE PIT,DRAINFIELD �
EICTN,.CESSPOOL.DRYWELL C .00 _ 12-.
HOUSE SEWER CONNECTING TO P,C.NO. O
PRIVRTE DISPOSAL SYSTEM OO CO.SMP, NO, �,M ,TOES N0. CJ
CONNECT ADDITIONAL T NO,BLDG.OR
TRUNK PERMIT NO, ROAD PERMIT
WORK.TO HOUSE SEWER .00 -
ALTER,REPAIR OA ABANDON I4iaUSE STATE ENCROACHMENT 0
SEWER OR DISPOSAL SYSTEM @ S,00 PERMIT NO. Ce?
INDUSTRIAL- — — Lu
i
WASTE APPROVAL to
CHARGES z
OVMEWS PERMIT - CONNECTION CHARGE FEE
AUTHO ;AT'ION I TOTAL FEE „ REIMBURS5VENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS—DAY OF 19— NEW HOUSE SEWER
OWNER OR OWNERS AGENT____L k ., CONNECT ADDITIONAL
_ - BUILDING OR.WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
-_ - - - - AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAVAS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. :SEWAGE DISPOSAL.5EROR _
I HEREBY' CERTIFY THAT I AM PROPERLY REGISTERED ARD/OR SEWAGE
AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUG AND _
CALIFORNIA OR THAT [�wM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDF,NTI L OPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PITS).Q1 CESSPOOLS
OF PgRMITTEF V
' ..VALIDATION ROBERT A. WOOD
Cx. M.O. CASH SUPERVISING MECHANICAL ENGINEER
: ,
A642D APPLICATION FOR PERMIT
�,a�az�
COUNTY OF LOS ANGELS SEWER-SEWAGE DISPOSAL,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FTIEAREIT
LDING -
JOHN A. LAMBIH, County Enlignea RE55 �WILLIAM A. IENS N, Supt ct Suilding� ALITY % ui.FOR "MCOT TO FIIJ IN SS ST, J ,� � I j I,
F.U,L..,N,.,
EGiL
ON LBY e"IO LEGALl.� 3 �..z::�i" a ✓ OWNERMAIL —
TRACH '' i
d V 7 i' 1 ADDRESS
FIA,OF SLOGS.
OFT NOW ON LOT CITY TEL. NO
USE DISTRICT NO. GROUP MAP PROCESSED BY
PG
CONTRACTOR .r i ,.. -_,. .. "---> A BIS �_
� `� � l :�,�t. qtr �. - .� ,U.4_.uy.�. t-
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ADDRESS
,_-y _C . -ti--_� F.� �-• CO CTION DATA y
CITY.¢` ]] TEL.N.O. e, STATION DEPTH # a
STATE MANHOLE REFERENCE LfP?ER``
REGISTRATION NO. l'' COUNTY .fir J a
NO. D—;CRIPT) N OF WORK FEE
HOUSE SEWER CONNECTING TO }
PUBLIC SEWER @ $ .00 - TYPE OF CON . DN LENGTH FROM
SEPTIC TANK,SEEPAGE'PIT OR Y, Ia.L. M.L.TO P.L. ` E
PITS AND/OR DRAIFIFIEL.D @ .00
OVERFLOW SEEPAGE PI'S,DRAINF'.IELD >_
E%TN_CESSPOOL DRYWE?L 0.
HOUSE SEWER CONNECTING TOP.C,NO, 0
ADD PRIVATE DISPOSAL SYSTEM C OD CO.IF I'. moo I ( ,SOB NO.
CONNECT ADDITIONAL I1I.M.by a./
TRUNK PERMIT NO. ROAD PERMIT t10. /�" t 'x
WOFtII 7O HOUSE SEWER � S 00 � f
ALTER,REPAIR OR ABANDON.ROUSE STA'iE ENCROACHMENT
SEINER OR DISPOSAL SYSTEM L� $ .QO ,PEPNIT NO.
INDUSTRIAL - - Eta
WASTE APPROVAL D`
t�9
CHARGES
O RES PERMIT 5 2 00 CONNECTION CHARGE FEE
A=OMZATION TOTAL FE � �ti." PEIMBURSCM.ENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONS — ++ DATE INSPECTOR"35FONAfUAE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALSI
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF—_19— NEW HOUSE SEWER
OWNER. OR CONNECT ADDITIONAL—
OWNERS AGENT— BUILDING OR WORK --
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAIN.IELD
I HEREBY ACKNOWLEDGE T17AT A HAVE Rr4D THIS APPLICATION
AND .STATE THAT THE ABOVE I'S. CORRECT AND AGREE 70 COMPLY CESSPOOL ® DRYWELL
WI'N 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 IAPS ;7N.E LEGAL. OWNER OF THE ABOVE -
DESCRIBED RESIDENTIA4 R -ERTYo BACKFILL SEPTIC TANKS
�' SrEP.Pi m,c] CESSPOOLS
SIGNATUREOF PERMITTE <..p,_.... $... "^.� �.a.-� _'s ,,�✓ a. .tet -
{ a
NALMATION ROBERT A. WOOD
cac. ae,0. e.Asra SUPERVISING MECHANICAL INGINEER
J