HomeMy Public PortalAbout10250 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL ��
VISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
F/�OyyR APPLICANT TO FILL IN LOCALITY
AD REISS (j Crl I� (@ ` CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST I^ A S
CROSS ST. (f,
RECEIVED BY Ready for Inspection DATE ISSUED
CWNER ��.� • --- —
i
MAIL c USE ZONE i OCCUPANCY MAF
ADDRESS ���.�''1,:. ., _� BK PG
CITY TEL.NO.
CONTRACTO "
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ADDRESS '1317 %Cs „y 6 arc s JOB NO.
CITY Orltebf` 'g O TEL.NI:N Z
TRUNK PERMIT NO.
REGISTRATION NO ?, s � q QOUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0, PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT - NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO.i DESCRIPTION OF WORK FEE
---- - REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO ___
PUBLIC SEWER @ $ 3.50 ),„5
_ _ RECEIPT N0. � 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. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 i
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 LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 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 APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
,�^,
SIGNED THIS (1 DAY OF.._{:.f.... .!...._.._. .._.19 NEW HOUSE SEWER <
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...... _�' �: _'.... BUILDING OR WORK
rar .
;> r SEPTIC TANK,SEEP.PIT(S)
ADDRESS ! __.y._: (4 _. ___ r- L 4 �«• AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ IS APP . CESSPOOL❑ 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
SEEP.PIT(S)o CESSPOOLS 0
SIGNATURE `-�"
OFPERMITTEE--•-`'.....`_.=.- ..............................--.........._...._.