HomeMy Public PortalAbout10257 OLIVE ST_Sewer__ A. EDEPA3iME1NT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
'"- COUNTY OF LOS ANGELES UILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY �- � �f � -•��
�y NEAREST [' '
ADDRESS 'D Cj� ! e X✓Ls1;�4 CROSS ST. •(JtfiD`
LOCALITY / /s'�'+H,:l !) �1 �`�. DISTRICT N0. SERIAL N0. PERMIT NO.
NEAREST A / Glc •�,. S
GROSS ST.
{ RECE(VEDIBY Ready for inspection DATE ISSUED•
i
OWNER a e �A /� '��•''n'� C ,�' �•a-�/"Jv
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
"� BK PG
CITY TEL.NO.
CONTRACm19PAmq ;�ST� a� CO.IMP.NO.
ADDRESS.1317 ('!nlPSr0%r@ Aw.e J013 1110:
CI P TE q , TRUNK PERMIT N0.
REGISTRATION 1Q .Z!A, J / r, • COUNTY ROAD PERMIT NO.LEGA
DESCRIPTION LOT N0. j / / 7..��..j D 7 SEAM1T NOTE ENCROACHMENTP .
BLOCK TRACT ��/ INDUSTRIAL ^----�
WASTE APPROVAL _
SIZE OF LOT f n
NOW ON LOTNO.OF S CHARGES
USE OF ��
BUILDINGS �trG[ CONNECTION CHAPGE FEE
NO. DESCRIPTION OF WORK FEE _ REIMBURSEMENT F
EE
EHOUSE SEWER CONNECTING TO
UBLICSEWER - -_ 8 8.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTI ECORDED
WORK TO HOUSE SEWER I:00
ALTER 8R REPAIR EXISTING NO- I DAT BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.002A0 CONIJ TION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD STATION (0-f- DEPTH
CESSPOOL—D RY W ELL
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE q�
3 -Q .XlfRER /p p,T LOWER
TYPE OF CONNECTION LENGTH FROM _=
OWNERS PERMIT I 00I-ylY $ _ M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I . 5 i
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE .DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS...-_._-..:__D F...__r r ._.._19_ NEW HOUSE SEWER x
OOWNER OR CONNECT ADDITIONAL
WNERS AGENT-:./4&- BUILDING OR WORK
ADDRESS,/..�.V_. SEPTIC TANK.SEEP.PIT(S)
. - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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 ABANDONHOUBESEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCH BED R SIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE ' s �} SEEP.PIT.(S)� CESSPOOLS
OF PERMITTEE_X
/�� ' � 1 •
_._._..__.__r,.�--••--
70AS48D 603 1/53