HomeMy Public PortalAbout10242 OLIVE ST_Sewer__ DEPAICrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY
PERMIT APPLICATION
C�I7NTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING - NEAREST
ADDRESS j i, �/ ( CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A J
CROSS ST.
RECEIVED BY Reedy for Insoeetton DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
- --- � BK PG
CITY TELAO. j
i
CONTRACTOR ftjif()T'+1' in SI-Acer Con!-,t n , CO.IMP.N0.
ADDRESS 1317 of g-',,,-``' - a TS_ JOB NO.
CITY Montebe a' o TEL.NO. ()n ? TRUNK PERMIT N0.
❑ STATE -
REGISTRATION NO.1 ❑ COUNTY ROAD PERMIT NO.
LEGAL - -
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
_ NOW ON LOT CHARGES
USE OF T
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO --- REIMBURSEMENT FEE
PUBLIC SEWER C $ 3.50 _ RECEIPT NO. DATE BY
HOU8E SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR 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
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL ----
SPECIAL CONDITIONS ONLY 2.00_ MANHOLE REFERENCE
UPPER L:rv:zG
_ TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE - -
1 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 _
�" NEW HOUSE SEWER
SIGNED THIS,,,,2 } IDAY OF__ ..___ ._.19__A.;�
NEROw OR ^'�JJ i� Ci �/J CONNECT ADDITIONAL
OWNERS ADEN // _ l s _ BUILDING OR WORK
ToU......---... - .._....__. ... w .............
ADDRESS.................:..... .. c,�/j� SEPTIC TANK,SEEP.PiT(S)
-1 �- / ._!___C-._-_- .*.....--.._x_4"5... ._...__p ANO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:I DRYWELL
CATIGN 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 t 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 El
SEEP.PIT(S)❑ CESSPOOLS
SIGNATURE /
OF PERM ...........
76AG42D 663 1/58