HomeMy Public PortalAbout10258 OLIVE ST_Sewer__ DEPART1tEOM OF COUNTY ENGINMR SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
' COUNTY OF LOS ANGELES �«
WILLIAM J. FOX. COUNTY ENGINEER I ADDRESUILDI S I D �• y ��,
FOR APPLICANT TO FILL IN J]�� LOCALITY
UILD //- ..QP
NEARES
ADDRESS �.} .2. 8s CROSS ST.
LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST 'j A - I��� S
CROSS ST.
/�
`� / RE EIVED BY Ready for Inspection DATE ISSUED
OWNER I % A P I'I /J rV��� PJ• V
MAIL n J
ADDRESS S A� USEZONE OCCUPANCY MAP
BK PG
CITY TEL:NO. A -1
CONTRACTOR �Z�i Sia `7`ry"''�'r const a. n 4 ill
51 o egrove Ave. CO.IMP.NO.
ADDRESS MontsbutioJOB NO. --z�
CITY TELAO: ion 1-504
TRUNK PERMIT NO.
L� r—e1
REGISTRATION NO. MT4 ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. ` I / I"— STATE ENCROACHMENT
PERMIT NO. R
BLOCK TRACT WASTE AP ROVALSTR .� _
SIZE OF LOT 75` I Nagy ON LOTS \CHARGES
USE OF om
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.60 RECEIPT NO. f 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 I DATE 18
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC PITS AND/Olt DRAINFGE DIT OR 2.00 ~
CESSPOOL—DRYWELL STATION `_- Q� g� DEPTH
SPECIAL CONDITIONS ONLY 2.00 �� �! MANHOLE REFERENCE
UPPER hewsn-
� TYPE OF CONN TI LENGTH FROM /
OWNERS PERMIT ; 1 pp — P• M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS INSPECTOR'SS GNATURE DATE
DWELLING TO THE PUBLIC SEWER.
SIGNED THIS.._- DAY OF_ 19 NEW HOUSE SEWER _
OWNER OR r CONNECT ADDITIONAL
OWNERS AGENT•r'+P -----...�� BUILDIgG OR WORK
ADDRESS . . �t' !.. SEPTIC TANK,SEEP.PITS)
` J 1 __....._.._......_... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVElk 13 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDIN CES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM P OPERLY REGISTERED DISCONNECT PLUG AND
AND LICENSED AS REQUIRED BY 'OS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CA IFORNIA OR THAT I. THE LEGAL OWN-
ER OF THE ABO D CRIB D SIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE J� /� SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE. _.
7BA642D 663 1/6S �, �