HomeMy Public PortalAbout10321 OLIVE ST_Sewer__ et-
6A642 D-64
76A642APPLICATeNFOR PER T
COUNTY OF LOS ANGELES SEW SR-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS j.
JOHN A. LAMBIE, County Engineer _ .'
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
FOR APPLICANT TO FILL IN CROSS6ST.
_ �+-- FML
LEGAL _-.. y.+ 15 .3 ��
DESCRIPTION LOT NOL y 4y��s/ y OWNER ';7• „ „ y
�G 7 ...3,5 �►�/g.�.• MAIL � g
BLOCK TRACT 4,
J � ADDRESS
— lJ j�' ri�•1'N O. OF SLOGS. '
SIZE OF LOT NOW ON LOT 1 CITY _ TEL. NO.
USE OF :� DISTRICT NO. GROUP MAP PROCESSED BY
BUILDING �_ BK P. (_PRO
h. -r
CONTRACTOR .. t• i �✓ -' �-'X�" '...
ADORES CONNECTION\DATA
_ T. ION �-- +,'DE
CITY 7PTH
A
UPPERSTATE MANHOLE REFERENCE
REGISTRATION N4,;?v
_ COUNTY
NO. I DESCRIPTION OF WORK FEE TYPE OF COfj ON LENGTH FROM
OUSE SEWER CONNECTING 7tl -�T- —_ Y. P.L. M.L.TO
HP,L.
PUBLIC SEWER $5.00 „ - -
SEPTIC TANK,SEEPAGE PIT OR r P.C.NO.
PITS AND/OR DRAINFIELD $10.00 CO.IMP.NO, JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERM I "r
PRIVATE DISPOSAL SYSTEM @ $3.00 _
CONN€CT ADDITIONAL SLDG.OR i AFFIDAVIT WAIVER EASE ENT RECORD.INSTR. O. AT a
WORK TO HOUSE SEWER 0 $9.00 O
OVERFLOW SEEPAGE PIT,DRAINFIELD +
EXTN.,CESSPOOL,DRYWELL,MANH E G $5.00 , u
ALTER,REPAIR OR ABANDON S N 7. t. N6N�C �' 'L- i o d
SEWER OR D'5P05_AL 5 TE- $3.00 Z
A � -Ir STAT ENCROACHMENT —
y PERMIT NO.
INDUSTRIAL
OWNER
WASTE APPROVAL
•O'rrirER�S PERMIT a CHARGES
AUTHOMATION TOTAL FEE CONNECTION CHARGE FEE
'I HAY' AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR UB 0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLISEWER, DATE INSPECTOR'S SIGNATURE
SIGNED THISOF 13V ---
OWNER OR .+�• NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
SU ILDiNG OR WORK
ADDRES6__ SEPTIC TANK,SEEP,PIT(S) r.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD A
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ❑ DRYW ELL ❑
PLUMBING AND SEWERS. _
1 HEREOY CERTIfYry THAT 1 AM PROPERLY REGIS7;E RED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS R_r i1�ED BY LOS ANGLES 40 NTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA O THA I AM THE LE G_ OW N,1Ck OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, 'E P�VE DESCRIBEDIRBSID IA PROPER+I'. ABANDON HOUSE SEWER
51OF PERMITTEE /NATURE "" k.. BACKFILL SEPTIC TANKS ❑
—'-- -- SEEP,PIT(S) ❑ CESSPOOLS ❑�
VALIDATION" ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. 1 CASH
766°8 3-64
76A642D APPLICATION FOR PE IT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING J
ADDHESSI
JOHN A. LAMBIE, County Engineer WILLIAM A, JENSEN. Supt of BuildingLOCALITYCROSSNEA�EiS7FOR APPLICANT TO FILL IN LEGALDESCRIPTION LOT NOcicOWNE
.��}} MAIL
BLOCK TRACT, " ' _ ADDRESS
C O. OF L 5.
SIZE OF LO A"ti_-- ._ T r� CITY • �' •TEL. NO.
U5E OF
BUILDIN DISTRICT NO.. GROIT
MAP PROCESSED BY
_ BK PG
CONTRACTOR _ -`- tr. -. d' .i•' J ...
' J` 3 CONNECTION DATA _
. s
I
ADDRESS--?, L✓--_�.ir+��
CITY - - TEL .A71ON '^7 _ EPTH
/i
STATE UPPER
REGISTRATION NO.. MANHOLE REFERENCE ,„,,.
NGESCRIP710N OF WORK FEE _ _ TYPE OF CONNE N LENGTH FROM fy
O.HOUSE SEWER CONNECT1111 TOY. +-? P.L. M.L.TO P.L. ♦,qC..V
PUBLIC SEWER @ $5.00 dY� --- - ---
P.C.NO.
SEPTIC TANK,SEEPAGE PIT OR ' ) �+'.,'�'�*"� 6.
TS ANO/OR DRAINFIELD EIO.00 CO.IMP. NO.71' _1T'llC -_ SOB NO. -
HOUSE SEWER CON NEGTI NG 70 TRUNK PERMIT NO. ROAD PERMIT f`/ V
PRIVATE DISPOSAL SYSTEM 0 $3.00
CONNECT ADDITIONAL BLDG.OR —{I— AFFIDAVIT WAIVER EASEMENT RECORD,INSTR.NO. DATE
WORK TO HOUSE SEWER @ $'«.o0 I _�
OVERFLOW SEEPAGE PIT DRAINFIELD I---- V
EXTN CESSPOOL DRYWELL,MANHOLE @ $5.00 jW
AlTER REPAIR OR ABANDON HOUSE
_�SEWER OR DISPOSAL SYSTEM $3.00 -"*ATENCROACHMENT
___.._-_� Z
r PERMIT NO.
-- -
INDUSTRIAL T
WASTE APPROVAL
CHARGES
OWNERS PERMIT sz o0
AUTHORIZATION rTOTAL FEE CONNECTION CHARGE FEE
'i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NIN N M REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. / DATE INSPECTORS SIGN,4ca(URE
SIGNED THIS _DAYS .�[�
OWNER OR ` � J/ NEW HOUSE SEWER
OWNERS AGENTO '—
-- CNNECT ADDITIONAL v
BUILDING OR WORK
ADDRE55,_ _ --- -- SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ------ -
WITH AL I_
COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANEVOR. A!..TER,REPAIR,SEWER OR
LICENSED AS REOUJ.REO BY LOS ANGLES COUNTY ND STATE OF SEWAGE DISPOSAL SYSTEM �`-
CALIFORNIA OR M THE LEGAL NER OF, NO INTEND TO DISCONNECT PLUG ANO
RESIDE IN, TH OV ESCRIBED IDEN AL OPERTY. ABANDON HOUSE SEWER
SIGNATURE ��- - ,"/t`f
OF PERMITTEE___ '� CKFILL SEPTIC TANKS ❑
-- SEEP,PIT(S) ❑ CESSPOOLS ❑
VALIDATION _ - ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O: CASH