HomeMy Public PortalAbout10205 OLIVE ST_Sewer__ DEPAWrMMNT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING • ., NEAREST
ADDRESSI CROSS HT.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST � t.� S
f
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER �
MAIL `
ADDRESS USE ZONE OCCUPANCY RK MAP PG
�r.�.�i.-�11
CITY TELAO.
CONTRACTOR '!' rm8��.,., CO.IMP.NO.
ADDRESS 1317 �>:1 �
?.�, '
" "t3---(1_- JOB N0.
CITY t C- 0 TEL. Q„ , TRUNK PERMIT N0.
TATE —
REGISTRATION NQ.(', x r, COUNTY ROAD PERMIT NO.
LECAL `' - -
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
4L I WASTE APPROVAL
SIZE OF LOT�Z, Nb.OF BLDGS.
? NOW ON LOT I CHARGES
USEOF
BUILDINGS % +e-i/ CONNECTION CHARGE FEE
NO.' DESCRIPTION OF WORK FEE --
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER Q $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING PO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER I.00_
ALTER OR REPAIR EXISTING NO- ( DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.09 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LQvImm
TYPE OF CONNECTIONLENGTH FROM
Ct�RB P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 00 Y.
AUTHORIZATION TOTAL FEE * z�
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS, i..:'.'7?--DAY OF..-_.-----;-r-__..... _......Igo- NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONKAL
OWNERS AGENT..................._..................-.............. --....:- BUILDING OR WOR
_--_--..--_............... SEPTIC TANK,SEEP.PIT(S)
ADDRESS-.-.--.--..
---,_....--. -- -.------'- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLI- CESSPOOL F] DRYWELL E
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED N
AND/OR LICINSED AS REQUIRED BDISCO
Y LOS ANGELES COUNTY _ARAN. ON
PLUG AND
ON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)[:] CESSPOOLS[:)
SIGNATURE i i)
OF PERMIT TEE:.rj,.rl..14. 4 ..¢:-..;. ;, ��,t L.iGw' ._--_.......
76A642D 663 1/53