HomeMy Public PortalAbout10215 OLIVE ST_Sewer__ .• -DEPAUTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL8971
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
—COUNTY OF LOS ANGELES
WILLIAM J. FCX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS ?_ . CROSS ST.
DISTRICT NO. SERIAL NO. PERMIT NO.
LOCALITY A S
NEAREST /
CROSS ST. -
RECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL
f✓I•s: �� �`" --
ADDRESS USE ZONE OCCUPANCY ( MAP
ADD
BK PG
CITY TELAO.
CONTRACTORCalif(}j+j' in Saw$ ' (!on-q,+ CO.IMP.N0.
ADDRESS 131`}' COle,.!z'Q y�. .�iif€, .. JOB NO.
;{t�
CITY ontet{' e 1(j TEL.N *" —
4r�a�ar1 3—�*r'-•is TRUNK PERMIT N0.
STATE
REGISTRATION NOl.C?I �� <COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. ) f• J c/ STATE ENCROACHMENT
_ f PERMIT NO.
BLOCK TRACT / INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT �L� N0.OF BLOCS.
4_J NOW ON LOT CHARGES
USE OF ?,,-
BUILDINGS 1 '- CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE - ----
USE SEWER CONNECTING TO REIMBURSEMENT FEE
HO
PUBLiCSEWER @ $ 3.50 RECEIPT NO. ( DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. i DATE 8',✓
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR --
PITS AND/OR DRAiNF1ELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER L0 E-R
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P BIC SEWER � ,��
SIGNED THIS.
25 AY OF..._ .:. _ __........19s. ,:� NEW HOUSE SEWER
i, ilc�C- I
OWNER OR CONNECT ADDITIONAL I�
OWNERS AGENTBUILDING OR WORK
.. SEPTIC TANK,SEEP.PIT(S)
ADDRESS,;.-=`z. �1 r.�..- ..... ... ... ...... - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS F
SIGNATURE SEEP.PIT(S)L7 CESSPOOLS(]
OFPERMITTEE------------ ---- - -------------•---------. ------. --------
76A642D 663 1/53