HomeMy Public PortalAbout10319 OLIVE ST_Sewer__ ?6A6� � APPLICATioN FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER--SEWAtGE`b ISPOSAL
Department of County= Engineer
County of Los Angeles BUILDING --JOHN A. LAMBIE,COUNTY ENGINEER —ADDRESS
CASSATT D. GRIFFIN, SUPT OFSUiLDING LOCALITY
- FOR APPLICANT TO FILL IN "Ross sr.
LEGAL
DESCRIPTION LOTNO. - OWNER
MAIL
BLOCS; TRACT - ADDRESS
NO. OFBLDG:S. CITY TEL. N0. -
SIZE OF LOT NOW ON LOT
BU I
USE OF DISTRICT NO. ,. GROUP MAP
BK
.CONTRACTOR - -
ADDRESS --- ---- �lCONNECTION DATA - -
----- - -- '-- ------ --_—..� _�. - STATION _�� DEPTH
CITY .—TI»L 1•40. ------ _ - - MANHOLE REFERENCE --- — UPPER
-t-1 STATE -------�.�----- ---
REGISTRATION NO, ❑ COUNTY
NO. 1 -DESCRIPTION OF WORK----- FEF. - ----TYPE OF CONNECTION � LENGTH FROM--�-- —
---
HGUSFBFsvER CONNECTING?O -- --- ---
Y.. CURB P.L.; M.L.TO P.L,
PUBLIC SEWER (a $.3.50 .—.-
SEPT!CTANK SEEPAGE P['[OR I -
PITS AND/OR DRA'NF ELD R $3.00
OVERFLOW SEEPAGE PIT, DPAINIELC --. - -..-- - P. C. NO.
FtTN..,C SPOQL,DPYWrLL,IdINnOLE 0,+, $2.00 CG, ?1i P. NO. JOB NO.
I F'Ot SE SEVER CONNE-T[NG TO —T -----j----____; ----
PRIVATE DISPOSAL SYSTEM (r:% $1,0G TRUNK PERMIT NO. ROAD PERMIT N0,
CONNECT ADOi TION AL BLDG.OR ._---- ._----_---__._.
I >TATL ENCROACHMENT
WORK To HOUSE SEWER (b $?.00 I I PERMIT NO.
AI 1R
-,- -
REAIP 'R tBulaiON-- 1,OSE
---- .---- -- ---- ------ - -------"--------'- '
! 1 INDUSTRIAL
SFSEt2 OR DISPOSAL SI ?E?+ (E ? )
- -- 'NASTE APPROVAL
CHARGES
------------------------------
I _
-.--. ---- -- �- k_ CONNECTION CHARGE FEE
OWNERS PERMIT ----— --'---------
AUTHORIZATION TOTAL FEE-- j I REIMBURSEMENT FEE
1 HAVE AT THIS DATE .A CONTRACT WITH THE, HEREIN NAMED CON- APPROVALS i DATE ;HISPHCTOR'SSiGNATURe
TRACTOR TO CONNECT THE AEOVE DcS f'PtBER E$157INCd DWELLING
TO THE PUBLIC SEWER.. - VEW HOUSE SEWER k � -
SIGNED TlilS_ .. DAY OF._--- -._ _l_ _'� .i9.. CONNECT ADDITIONAL
OWNER OR _ PUILDING OR WORK
-- -- ---i- --- -- -- -- —- -
OWNERS AGCN7',_.,._ SEPTIC LANK,SEEP,PIT(„)
ADDRESS___.-_-...----- -. _— h J;'CSF DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I FI.AVF. READ THIS .APPLICATION -- -
°T :a CORRECT AND AGREE TO COMPLY ..ESS`POOLLI DRfWELLO
*!D ATE THAT THE -nvSE _.._ _ __.-_.- __.-_ �___y-------_._._.-._..__-.__,___
v`f.17'H ALL COUNTY ORDINANCES A.NO STATE LAWS REGULA,HNG ALT REPAIR.,SE VER OR.. '
PLIUIMB<NG AND SEWERS_ LWAJE DISPOSAL.SYSTEM j !
I hrR -iY CERTIFY THAT ! ASI PROPERLY REGISTERED ANL'!GR DiSCCNh FCT PLL AND
R
LICENSED AS R Q ,RED BY LOS ANGELES COUNTY AND STATE OF ;-.NN Ohl HCU5�S1j
C'.ALIFORNIA OR THAT I Alt '[HE LEGAL OWNER OF THE AGOVE -AB-A1+."E
------._---'. ---..----- -..._------__-__-
DESCRI3E.D RE510Fq`!.AL PROPLRTY.. ,CKt '.LSEPTICTANKS' 1SIGNATURE -
E�. 1 t31 !._ CEaSPCJL
1 I
OF
JOHN A. LAMBIE, COUNTY ENC.fNEER VALIDATION R OBEF?T A. WOOD, CHIEF PLHG. INSPEC-i'OR
CK. M. E!
0. CAS
In
76A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNT)? ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
S.
ARr /*
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY 7L
REST EEE---
FOR APPLICANT TO FILL IN CROSS.-ST.
-- -—------
DESCRIPTION LOT NO.
c OWNER
MAIL
BLOCK TRACT ADDRESS
NO. OF BL D GS,
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT 10.,l GROUP MAP PROCESSED BY
CONTRACTOR
-K P-
ADDRESS �"` CONNECTION DATA
STATION DEPTH
CITY TEL. NO.
STAT UPPER
E MANHOLE REFERENCE
Y 1431 IJ
REGISTRATIONCOUNTY
No. DESCRIPTION OF 3ORi�e TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER $5.00
SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. JOB No
1[2.
NO_
PITS AND/OR DRAINFIELD
@_$10.0 0
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U
PRIVATE DISPOSAL SYSTEM $3.00 AW
CONNECT ADDITIONAL SL_15G_d_R VLW7SAWENT�CORD.INS
WORK TO HOUSE SEWER $3.00 Al FIDA TR.NO. DATE
OVERFLOW SEEPAGE PIT,DRAINFIELD U
LEXTN.:CESSPOOL,DRYWELL,MANHOLE @ $5.00— HWY.OR ST.WIDENING Uj
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM IS $3-00
STATE ENCROACHMENT jj C z
4
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL Z/
CHARGES v
OWNER'S PERMIf $ 2 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RE
�W!URSEMENT FEE
TRACTORT TO
CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
To THE ,U5LlC SEWER. APPROVAL _TTE'/ j_.-SF_ TOR'S SIGrTURE
SIGNED THIS—DAY OF _19— NE HOUSE SEWER
CONNECT ADDtTIONAL___�flML
OWNER OR
OWNERS AGENT
ADDRESS
BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING
ING AND SEWERS. CESSPOOL El DRYWELL 0
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND'"OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED
By LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA
A OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
DISCONNECT PLUG AND
RESIDE IN, THE ABOVE, DESCRIBED RESIDENTIAL PRIERTY ABANDON HOUSE SEWER
SIGNATURE
OF EE BACKFILL SEPTIC TANKS ❑
SEEP,PITS) ❑ CESSPOOLS ❑
VALIDATION.- -- ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. W 0. CASH
LF j-