HomeMy Public PortalAbout10219 OLIVE ST_Sewer__ Y)EPA$TDiENT OF COUNTY FNGINFER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING _
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY- ` ,. _
BUiLD!NG % NEAREST
ADDRESS f x a l�-+ (,� iG' _ GROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST �t C
CROSS ST. -------
� RECEIVED BY Ready for Inspection DATE(ISSUE
OWNER- t—E�C� l2- t:3 E? C_!� Ln: 1 y �4'
MAIL
ADDRESS >� J j USE ZONE OCCUPANCY SK MAP PG
CITY Lf TEL.NO. W
CONTRACTOR
CO.IMP.NO.
ADDRESS JOB.N0.
CITY TEL.NO• • f TRUNK PERMIT NO.
REGISTRATION N0. STATE y COUNTY ROAD PERMIT NO. �-
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT Y3 7f INDUSTRIAL I
WASTE APPROVAL
SIZE OF LOT N0.OF BLOG8. CHARGES
NOW ON LOT
USE OF o j —
BUILDINGS y,-l/ � CONNECTION CHARGE FEE
NO. I DESC IPTION OF WORK FEE REIMBURSEMENT FEE
l HOUSE SEWER CONNECTING TO
PUBLIC SEWER $ 3.50 —RECEIPT NO. t 'DATE BY
HOUSE SEWER CONNECTING TO }
_ PRIVATE DISPOSAL SYSTEM 1.00__
CONNECT ADD1710NAL BLDG.Oft *°' EXCEPTION RECORDED
_WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION_ DATA
SEPTIC TANK,SEEPAGE PIT OR q
PITS AND/ORDRAINFIELD 2.00 STATION -4 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I p MANHOLE REFERENCE
TYPE OF CONNECTbO� LENGTH FROM
�MRY. P.L. 111.L.TO P.L.
OWNERS PERMIT 1 00 [ALTER,
_ -
AUTHORIZATION TOTAL FEE - -
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTINGPPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER f
SIGNED THIS.._.._ DAY OF.. Iq OUSE SEWER
OWNER OR ECT ADDITIONAL
Jtt ING OR WORKOWNERS AGENT.._.K.__! C TANK.SEEP.PiT(S)
ADDRESS-._ •----... 0It I NFIELD
I HEREBY ACKNOWLEDGE THAT I HAYS READ TH18 APPLI- OOL DRYWELLCATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. GE DISPOSAL SYSTEM
I HEREBY CERTIF HAT I AM PROPERLY REGISTEREDNNECT PLUG AND
AND/OR LICENSED,• S EOUIRED BY LOS ANGELES COUNTYDON HOUSE SEWER
AND STATE OF C/CLIFO IA OR THAT 1 AM.THJE LEGAL ON)N-
ER OF THE ABOiiFF££ D CRIBED SIDENT RO ERT.Y. FILL SEPTIC TANKS
SIGNATURE �,]] .PIT(S)[] CESSPOOLS
OF PERMITTEE......... .
76A642A 663 7/53
;)EPAICTAIENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ! BUILDING
I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING - NEAREST
ADDRESS CROSS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. �e RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ,,//1/
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
------ - - BK PG
CITY TEL.NO.
CONTRACTOR tallfor-rilln q",zAr GO>E}r4 ' CO.IMP. NO.
ADDRESS 1317 00ing7 OUP Awes JOB NO.
CITY02It per, TEL.NO. T TRUNK PERMIT N0.
SPATE
REGISTRATION NO. `444,,;5 COUNTY
� ROAD PERMIT N0.
LEGAL A-+� STATE ENCROACHMENT
DESCRIPTION LOT N0."' / !/ _ PERMIT NO.
BLOCK TRACT ;' '/ INDUSTRIAL
T WASTE APPROVAL
O.
SIZE OF LOT V fa ^ NNOWOF OBLDGS.
N LOT CHARGES
USE OF ^A
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER_ @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD6.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.0_0
ALTER OR REPAIR EXISTING N0. DATE ! BY
SEWER OR DISPOSAL SYSTEM 1.00
131"SCONNEI&T AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR --
PITS AND/OR DRAINFIELD 2.60 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
—I UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE — ---
I 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.'._ ...:.....DAY OF.. 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL v
OWNERS AGENT_.-_r_- i ,�--- -------
BUILDING OR WORK
- - ---
- SEPTIC TANK.SEEP.P1T(S) 7
ADDRESS. - -_.:. - -". -
........... -------- s AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 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
I HEREBY CERTIFY THAT I 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 E]
SIGNATURE SEEP.PIT(S)[-j CESSPOOLS E]
OF PERMITTEE-•-----•------•------- ........................... -
76A642D 663 1/53