HomeMy Public PortalAbout10406 OLIVE ST_Sewer__ y.
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7cA642U APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING FIND SAFETY DIVISION eU1Lo1NG (yip f � • y
Ia County A. LAMEIE, CouEngineer ADDRESS v
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WILLIAM A. JENSEN, Supt of Building
LOCALITY
- NEAREST
FOR APPLICANT TO FILL IN CFDSS 5Y' �--
LEGAL
DES RiP'I.ION U7 NO OWNER j,y`' ,,y,,y�^gj a..•,,y¢
MAIL
O:.00H TRACT-Yf �"' =. ADDRESS
rio OF 33L GS.
SIZE OF I....,", NOW ON LOT CITY TEL. NO.
USE O`F
UP
DISTRICT NO. GROUP MAP PROCES
BUILDINGS �E.„q BY
BK PG
CONTRACTOR J� -i
ADDRESS .,., r CONNECTION DATA
CIT .✓,y)� .Td' py�.�PLU! t.j DEPTH
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+-yy 4y�STA7c. t+[ANY,O>..E REFER£t c.E.:'-f-
4EG1 7RA7ION NO:___.,y '_ `. T fz
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NO. DESCRIPTION F WORK 'FE _ YPF OE 'O�NECT tON ;' � LE�iCTH FROM
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HOUSE 5hWER CONN E._'CtNG YO I Y + � TI,� F r. t+1.L 7O P.L,
PUBLIC1=WER @' $5.UC _ _._- __ ___ __
-.-__ _
PITS AND/OR
-- -. P G NO
TAMC RAN GE plT OR ' � JOB NO
SE-TT
ND FURDRAIF(EL,U @ CO MI' NC+ �
TRUNK NO.
- I CONNECT ADD TIUJNAL BLDG.OR �a 3.0U _- AFFIDAVIT PERMIT WAIVER EAGEM£NT f ROAD
� DATE
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FRIVATE DISPOSAL SYSTEM @
I WORK lO HOUSE
SEWER @ $300 ( �
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t 7CTN...CE.:SPC�OI.,OR'+WELL MANIiOLE� a5.UU
-_._ HWY.Oil ST.WIDENING +�«
ALTER.REPAIR OR ABANDO OUST' ._...
W'ER v�.< <:) AS Y_ M S3.00 ...S7ATEE1`dC P.0.4Ln MENT
—.._ - —_ PERMIT NO.
_- —L C _
CHARGES
VSvT' l�
ONFR' IBERMIT
_ -THORIZATION]_ -�- - -- -- -_-_ -- — CONNECTION CHARGE FEE
AUTHORIZATION]- `TOTAL FEF, r'
1 HAVE: AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT 'THE ABOVE DESCRIBED EX S-iN6 DWELLING - - - --r -- -- --
'O HE PUBLIC SEWER, APPROVALS DATE f INSPECTORS SIGNATURE
S1 GIN EC. THIS DAY OF_-_—_�_-.—_._i��_
OWNER OR NEW HOUSE SEWER ._ .-.._
OWNERS AC CONNECT ADOIT{ONAL
BUILDING OR WORK mj
ADD 4S
-- - ---- -- - -� SEPTICTANK.SEEP'.PITts)
1 HFREB%' ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION A.ND:ioR OFt.AINFIELU !
AND iT.ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _._.
WITH ALL'
COUNTY ORDINANCES AND STATE LAWS REGULA'TfNG
PLUMBING .ANO SEWERS. CESSPOOL. CRY4VE.LL
HEREBY RTIFY THAT I RM PROPERLY REG IS7E R''U AND/OR ALTER.RF.PAI77. GUs'ER..UR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM �
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AN_p INTEND TO D Sr UNNL- - - _ - ----I -- --- --�---
R'ESiDE !N, THE: V i:5 RESl NT7AL P ERTY C PLUG AND 1
," :.�; qty '. ABANDON N ri O.UG EW R
SIGNATURE �_- #- .- �d._/, -
BACKFIL.t 5E T r TANK. I
G>P PER.M!'!'T E s-j( ._._.- SEEP.PIT(S) ❑ CESSPOOLS 0j
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.c”. CASH
76A6420 APPLICATION FOR PERMIT
COUNTY OF COUNTY
DEPARTMENT OF COUNTY ENGINEER SEINER-SEW
AGE DISPOSAL
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Sup't off Building LOCALITY i-;, r
NEARFST
S
FOR APPLICANT TO FILL IN CROSST.
DESCRIPTION LET'IQ C1WNFR
CK T R AC,T MAIL
SLP
ADDRESS
NO. OF BLDG
-SIZE OF LOT NOW ON LS.
OT CITY TEL. NO,
USE OF
gU ILD 1 N GS DISTRICT NO. GROUP MAP PROCESSEPBY
SK
CONTRACTOR PG
ADDRESS CONNECTION DATA
14
k ION DEPTH
CIT
--y
Ir
COL,`TTY
MANHOLE:REFERENCE
REG,STRATION NO. Vc �Os",
Nb F 15E FEE
t,R K
SCRIPTION O�
TYPE.OFCONNECTIONI Z" LENGTHFIROM,
HOUSE SEWER CONNECTINTO QV�S P.L. WL.TG_P.L
I G
PUBLIC SEWER $5.00
SEPT7
-1� ANK7SEEPAGE PIT OR v
ITRt
4D DRAENFIELD C.O. .IMP. N
------- LP $H).00 JOB NO.
HOUSE SE-W-f—,-P CONN-EfTING To TRUNK PFRM!T NOROAD PERMIT NO
PRIVATE DISPOSAL SYS-TEM. @ $3.00
. .
-F
CO0 -ONNEC7 ADDIT! NAL 51. G.OR AFFHDAV1i W -ASEMENT .0iNSTRNO. DATE
A VER!
WORK TO HOUSE SEWFIR rt) $3-00
E:XTN CESF-O0L..DRYWtLL.MANHOLE $5,()0
ALTLR.REPAiRnR-AF3AN`OON H`C1`,jSE:----- HWY, OR ST.WIDENING
5EWEH OR DiSPO�,AL SYSTLM op ENCROAC --E-- -- ----
HM, NT
PER
Nit I No
!NDUST�,4AL
24
OViNER'S PERMIT 2CHARGES� 00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT 'THIS DATE A CONTRACT WID'WITH THE HEREIN NAMECON REIMBiURSVMENT FEE
TRACTOR To CONNECT THE ABOVE GE SCRIBED IFYiS7!N OW FLLING
TO THE A
PUB IC SEWER. APPROVALS DATE INSPECTOR SiGNAVURE
SIGNFD THIS DAY ---------1____--
OWNER OR NEW HOUSE SEWER
CONNECT ADDITIONAL
ADDRESSBUILDING OR WORK
SEPTIC TANK;SEEP.P.
AND, DNA.NF ELD
AN,DHEREBY AC�KNOWLEOGE YHAT I HAVE t READ TH!G A.
P.PIT(S)
, 5"ATE THAT THE ABOVE ISSCORREC- A-40 AGREE TO COMPLY
WITH DiNANCF AND STATE LAWS REGULATING
,�U,,,SALL 'LOUCOUN Y OR
ING AND SEWER, LESS POOL. ❑ DRYWELL
• .ER E By CERTIFY THAT I AM PROPERLY REGISTERED AND/011. ALrFR,REPAIR,SEWER OR
Li ENSED AS REQUIRED 13Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORN I A OR -THAI i AM THE LEGAL OWNS OF, AND INTEND TO
R 0 N I OISCONNECT PLUG AND
ESiDF IN, ABANDON HOUSE
I — PR, T�-
0 IT,
$IGNATrURE
V ' R BACKFILL SEPTIC TANKS tJ
SEEP PIT(S) CESSPOOLS
_j
.�--YALIDATION ROBERT A. WOOD
M.0 CASH SUPERVISING MECHANICAL ENGINrER