HomeMy Public PortalAbout10231 OLIVE ST_Sewer__ DEPAICfMENT OF COUNTY ENGINEER SEINER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
- COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
III ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS "; i L _ _ CROSS ST.
LOCALITY ` _ DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST.
OWNER "' -+'
RECEIVED BY Ready for Inspection DATE ISSUED
MAIL "
ADDRESS / SS USEZONE OCCUPANCY I BK MAP
-- -------- _._ PG
CITY TEL.NO.
CONTRACTOIialifornia SCgST' r� g; neCO.IMP.NO.
ADDRESS 131(ry (;C;o_7 c;- n:, `i.. >;JP„ JOB N0. -..-- —
CITY.?40ntebel-1,.ey TEL.NO, r^.r; „< TRUNK PERMIT NO.
�£STA'TE
REGISTRATION NO, C p. &OUNTY ROAD PERMIT NO.
LEGAL rr:. ... . } + �`s"�t
DESCRIPTION LOT NO. + .i i w .d L� STATE ENCROACHMENT
f PERMIT NO.
BLOCK TRACT f l INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT k` N.. �f`j BLOBS.NO.OF
NOW ON LOTI _ CHARGES
USE OF
BUILDINGS), mid) CONNECTION CHARGE FEE
No. ' DESCRIPTION OF WORK FEE
-- REIMBURSEMENT FEE
HCUSE SEWER CONNECTING TO
f PUBLIC SEWER Q $ 3.50 G RECEIPT NO. DATE I 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 ND• I DATE BY
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 DRAINFIELD 2.00 STATiON DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
upfIF R LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMITS I 00 Y CURE P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE G:
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS __-DAY OF.............._-;_-__-._.._.•_-_-_-. NEW HOUSE SEWER �
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT..__.'...._.._ ..
.... ...:_:.........-.............._. --•---- BUILDING OR WORK
....._- SEPTIC TANK,SEEP.PIT(S)
ADDRESS........
---_-----------... ..........•-----------•------•----- - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL E]
CA
TWN 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❑ o
SEEP.PIT(S)E] CESSPOOLS �.� -� ✓f > 107
SIGNATURE JI j J7
OF PERMITTEE... _------------- ✓_k �-
76A642D 663 1/53 s i