HomeMy Public PortalAbout10401 OLIVE ST_Sewer__ S1A >a APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMSE, COUNTY ENGINEER -ADDRESS —
E3 CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY
_ FOR APPLICANT TO FILL IN NEAR s.-
LEGAL ---- -- — - - ,.. OWNER ..DESCRIPTION_____ LOT LOT NO
77
MAIL
BLOCK TRACT _ •- _ADDRESS
NO.OF BLDG$. CITY TEL. NO.
S77.E OF LOT NOW ON LOT-
USE
OT
USE OF _ -BUGS DISTRICT NO, I GROUP MAP
ILDINb,
CONTRACTORqy"`a
BK PG
CONNECTION
CITY .'7E,L NO. `7AT703d DEPTH
-- -- -i --- ---- --` -= MANHOLE REFERENCE _{UPPER
STATE
REGISTRATION NO. COUNTY
NO DESCRIPTI:OP4 of WORK_ fF� __ ----- - --- -- `---- -
rHCUSF.5E&UtR COhN�CI I1G TO TYPE OF CONNECTION.-,- LENGTH FROM ,o'
--- I --- " -----' CURB {`¢.L &° L.TO.P.L, ,.�.;�
PUBLIC SEWER _ �a $ ,5C -__—. j}—�_
i
j SEPTICTANK SEEPAGE PIT OR -
!_PITS ANC OR DRAiNF FL's (a $s.00 _ -- - ---- --
-- -- -- - --- ---
j CVER LOA SEEPAGE P T,DRAiNFIELD I _ ✓ ,� P C NG..
FX111 ,Cr.SSP00l„CRYW�LL,h ANHOLE &Z a<<".DC C'0. IMP. NO. -4 41 JOB NO.
HOUSE St'NER.,C-0NNECTING TO
I PRIVATE DISPOSAL.SYSTEM -.--____ Cr �t,OD j � TRUNK PERMIT NO.. ROAD PERMIT NO.
I CONNECT ADDI'ICONAL 3LD6.OR I- STATE ENCROACHMENT -
' I. WORK TC HOUSE SEWER Cr s 1.0c 1 PERMIT NO,
ALTER,REPAIR OR ABANDON HOUSE
SI 'NUUSIRIAL. '
I:
SEWER OR SP,)SAL SYSTEMWASTE APPROVAL
CHARGES
I
.ONNEC TION CHARGE FEE
OWNER'S PERMIT 00 --_ -- ------__—__—___—._----____-
-._� 1 F'1MBUFSEt¢ENT FEE
AUTHORIZATION
s{TION TOTAL FEE
ifl 6J A 63&�illA'a"L L
1 HAVE APPROVALS DATE DATE I I NSPECTO .,SIGNATURHAVE ^,1 7H[ DATE A CONTRACT WITH THE HEREIN NAMED CON- _- ---
TRACfOP TO CONNECT THE ABOVE f)FSCPTEED EXISTING DWELLING
1'0 TiiE PUBIAC 51%VER.- ;d E4°d HOUSE SEWER -
S1fGNED THIS ____DAy C^_' - –
--'�� i`-=- CONNECT ADDITIONAL
OWNER OR - � ,� GUiLDINC OR WORK
OWNERS /AGENT ,+ ,%r - _---- -- -- ---- - -- --- ----
""'"' ._.'' '."s -- P?'` TANK,SEEP,P 1 T L S �
ND;'OR DRAINFIELD
--�-- ---
HFPBy C! 04 EDt ri-H:T I HAVE READ THIS ADPL IC TCN -- - --_. _
C ESSFOO ,_ JaY 1tLt
AND STAIC T: HE AB—)VE S CRRLCI AND ACfEE TO ..GN.Lr .--------
,vl ALL '(UNT OR:. N.a.\.:ES fiht) SATE LAI&S REGULATING t.LTER, REPAIR,SEWER OR
PLU,W.BlNG AND SHWEIZS, 51:4&'AGE DISPOSAL SYSTEM
H .ES CERT.f THAT ; AA PROPERLY REGISTERED AND/OR - ....------- --.... .-------_--
Li C.EN I a5 EU KI„c„ 6 LOS ANGELES COUNTY AND STATE OF L.fSGOh NN t,T'PLUG AND
CALIFORNIA OP. }LAT A-t fHE� LEu_0.L UVlNER-L�' THE ABOVE IS3AN N1?OUSESPWEi2
DESCRIBED R(,'I'RT"Y. :ACR: it L SEPTIC TANKS -
,LEP. I'Si 2 CESSPOOLS; �
'SIGNATURE. ---.-
OF PERMITTEE
JOHN A. LAMBIE CoutVTY ENGINEER VALIDATION 'rROBERT A. WOOD, CHIEF PI_OG, INSPECTOR cy_ CASH/
F808 6.88 APPLICATION FOR PERMIT
F808 8 7
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �
ADDRESS
JOHN A. LAMBIE. County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY_
NEARESTFOR APPLICANT TO FILL IN CROSS ST.
LEGAL ?
DESCRIPTION LOT NO-") _ - OWNER J
BLOCK TRACT �— _ -MAIL
ADDRESS
NO.OF P,LDGS. —
SIZE OF LOT NOW ON LOT CITY TEL. NO. -
USE OF
BUILDINGS D STRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL.NO. STATION DEPTH
-STATE ;4ANHOLE REFERENCE _ UPPER
REGISTRATION NO, ❑- COUNTY -- ..
NO. DESCRIPTION OF WORK FEE
HOUSE SEWERCONNECTING TO -
PUBLIC SEWER (V $3: 0 vj TYPE QT'CONNECTION LENGTH FROM
GA
SEPTIC TANK,SEEPAGE PIT OR Y. . RB P.L.- M.L.TO P.L.
ITS AND,,/ORDRAINFIELD @ $S a 0
OVERFLOW SEEPAGE PI'f, DRAINFIELD •''g f> �' 1 f�-
EXTN..CESSPOOL, DRYWELL @ $ 00
HOUSE SEWER CONNECTING TO t. '�. P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1100 CO.IMP.NO, JOB NO.
CONNECT ADDITIONAL BLDG,OR --
WOR.K TO HOUSE SEWER @ $1100 7RUNY.PERMIT NO> ROAD PERMIT NO.
ALTER,R& A —?,.R {I.r.C!;;.3N HOUSE STATE ENCROACHMENT
SEWER OR-D.r»- :.. is,-F-M C� siloo a _PERMIT NO. _
INDUSTRIAL
WASTE APPROVAL -
_ CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 1- R£IMPURs£MENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE. HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST;NG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS _DAY OF_ _A9.__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT______ BUILDING OR WORK
SEPTIC TANK.,SEEP,PIT(S)
ADDRESS_ _. __ AND/OR DRAINFIELD
I HERFPY ACKNOWLEDGE. THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL. [I DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR t
PLUMBING AND SEWERS. ALTER,
DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON P.OUSESEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAI..PROPERTY. + BACKFILL SEPTIC TANKS El
SEEP,PIT IS 1L CESSPOOLS
SIGNATURE f (]
OF PERNITTE -
�' VALIDATION ROBERTA. WOOD
t CK. H,0. CASH SUPERVISING MECHANICAL ENGINEER
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