HomeMy Public PortalAbout10116 OLIVE ST_Sewer__ e.g4213 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer IIIIIIII
County of Los Angeles BOILDI1r �-
WNL J,FOX. COUNTY ENGINEER ADDRESS �I / &:
CASSATT D.GRIFFIN,SU1PT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN CRA�ESr
LEGAL
DESCRIPTION�LOT NO.
R y - OWNER
BLOCK TRACT MAIL ..�. r, ...
ADDRESS '} it ✓_ L z.lr' _
SIZE OF LOT .NO. OF BLDGS, •"`�"
NOW ON LCT r.t -CITY ,�,�'_ ,� �` �.:- TEL. NO.
USE OF ,�'.''.�
BU LDINGS DISTRICT NO. GROUP f MMA.P
BK
CONTRACTOR _. .
ADDRESS ''`",'+++IIi " ,,.�. ; r t r ',�' '' , _--- -_. ._._.___-_—..�COY3EC°t'YC)A DATA ----..
e' 1 STt7fON t,�� " .'
CITY
.t°`_a`' r "-- TEL. NO - f w, !, t trl 1: _
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tye STATE S.IANI OLEEREFE R NCE
REU'PSTRATION NO, a ' tJ COUNTY
NO. DESCRIPTION OF WORK FEE ----- — __--
I+CU E SFV LR CONNLCI' N TU' TYPE OF CONNECTr 1 LENGI{ P'RO41 Ot
_--
.' PUBLiC SEWER
CURB P L. N L.. 10 r .
HOUSE SEWER CONNECTING
PRIVATE I)TESPOSAL SYSTEM 7 00
CL,NNECf ADDITIONAL BLDG. OR I P C NO -
EWG1R. TO LICUSE SEKER t.00 Ico, iWIP_ 14C.- JOB NO. I
j At.TF.R OP REP YIR cnl w-lfu6 ++ _
`_j SEV9ER R D- POSA YST_H —_v _ S.CO 1SKUNK PLI'M17 Td0 ROAD PERMIT NO,
D15CON'_NEECT AND A8ANDIDN SEWER STA'I'R ENCROACHMENT
A dDr03 D35?^S.WL 15 r=bi 3.00 _ PCR hill' Pi G.
-- —�
��� SEPTI, TANK,SECP CL PIT OR
61,S RND/OR DR INF�IE O 2.02]__ INDUSTRIAL
_ _ -- 4v AS TE aPPROVA! ;
C£ SPOOL DRY W LL � .I
SPECIAL t,LAID1T10Pda ONLY 7 OO CHARGES
- _- -..
PERa�IYT 5 i ofl CONNECTION CHAPSIE FE
CSEIr° --- -. ---- ----.
AUTHORIZATION I TOTAL FEE , � �, RFIMSUR$EMENT FGF
I HAVE T,," DATE 'Jv `?ACTED WITH } HEREIN ME CON
E.
TRACTORO CONIN CT THE ABOVE DESCRIBED EXISTING DWELLING APPROViALS DATE 1I'NSPECTOR SSICNATURE
0 TH,r_ PUBLIC �;ZWER �^•�- --_ _-�. _-___ I __ - _
SIGNED THIS.._....,c'DAY OF e - 9 NEW t ousI SEWERQtiNER
7 `) CONN CI ADDITIONAL �; 1
OWNER AG
r ^� '7 �� BUILDING OR 04'k _
OWNERS AWENT-_-��v,,�e.�d�„ 1"�'"�.�_ '� -_ ._.
✓,? SEPTIC TANK,SEEP, PIT(S)
ADDRESS 'Y' AND/OR_DRAINFIEL_D
1 HEREBY ACKNOWLEDGE THAT I H44 READ THIS APPLICATION CESSPOOL[] DRYVdELLL]
AND S"fATE THIAT THE ABOVE' IS CORj�ECT AND AGREE TO CO AMPLY I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -kLT'ER, REPAIR,5K'VJER OR
PLUMBING AND SEWERS, _SE"ArAGE DISPOSAL SYSTEM
I
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/CR '---. _ - _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND -
CALIFORNIA OR THAT I AM THE LEGAL, OWNER OF THF ABOVE - AI3 ABOFt HOUSE g±_E?
DESCRUBFD RESIDENTIAL. PROPERTY.
BACKF'ILL.SEPT C TANKS I._,, j I
SSIGNATURE
EEP Pi (S) C] CRSSPCOLS r� E
OF PERMITTEE " _"✓ - ?TM e~
WILLIAM J.FOX. COUNTY ENGINEER VALIDATION R.A.WOOD,Ch'IEF PLBG. INSPECTOR
11 to
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