HomeMy Public PortalAbout10335-10335 1/2 OLIVE ST_Sewer__ DEPri2C'CMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST.
RECEIVED BY Ready for inspection DATE ISSUED
OWNER V
MAIL
ADDRESS USE ZONE OCCUPANCY SK 10AP PG
CITY TEL.NO. , "" xv
CONTRACTOR CO.IMP.NO.
ADDRESS JOB NO.
CITY TEL.NO. TRUNK PERMIT NO. ----
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT ?,a 7 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BL CHARGES
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER Q $ 3.50 I RECEIPT NO. _ DATE I BY
HOUSE SEWER CONNECTING TO I(
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I 1.00 DATE BY
_
SEWER OR DISPOSAL SYSTEM
DISCNNNECT 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 y,l j MANHOLE REFERENCE LOWER
_ TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ! 00 si-_ P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
1 HAV£ 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-------_...........DAY OF...._._...................... 19._____. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..................._............................................... BUILDING OR WORK
..................................... SEPTIC TANK,SEEP.PIT(S)
ADDRESS.........
--.--•............._._.--._-•-.---..-•----• AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLY- CESSPOOL 0 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 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
SIGNATURE SEEP.PIT(S)E] CESSPOOLS[_
OF PERMITTEE_:--.l,' 4:..c............-................................._
76A642A 663 7/53 °"