HomeMy Public PortalAbout10425 OLIVE ST_Sewer__ YDEPART1 IMM OF COUNTY ENGDU= SEWER—SEWAGE DISPOSAL 10 4, g 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER I BUILDING
ADDRESS Iy �� r ("'• ! (t!
LOCALITY „• . � J.• , ;
FOR APPLICANT TO FI IN ��
BUILDING/,; ' NEAREST /
ADDRESS ti� CROSS ST. ,`tiej-6,,T'{�--t f
LOCALITY r DISTRICT NO. �/SERIAL NO.. PERMIT NO.
NEARESTfi /f A ,�{J/ S
CROSS ST. s �GL,/sf w E_t jj
�- / //---- RECEIVED BY Ready for Inspection DATE($SUED
OWNER �L
ADDRo � � USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO, A ' I ;
CONTRACTOR Cali.f ornia. Sewer rn• -.zt— CO.IMP.N0:
ADDRESS 1317 Colegrove Ave, JOB.NO.
CITY lWont ebell o TEL.NO'�i on 1-50469 TRUNK PERMIT NO. --
REGISTRATION NO. 104445 9lu) 8TA
'2� ROAD PERMIT N0.
NTY
LEGAL
q
DESCRIPTION LOT N0 .
. � M �'1.--6b STATE ENCROACHMENT `
PERMIT N0.
BLOCK .TRACT)�.(J aZWr(� WASTSE APPROVAL f
SIZE OF LOT6' ��/� NO.OF BLDG&
NOW ON LOT CHARGES
USE OF S CONNECTION CHARGE'FEE
BUILDINGS
• NO. DESCRIPTION OF WORK FEE REIMBURSEMENTFEE f
HOUSE SEWER CONNECTING TO
PUBLICSEWER. @ $ 8.50 RECEIPT NO. D TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSALSY8TEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION R CORDED
WORK TO HOUSE SEWER 1.00 N0.
ALTER OR REPAIR EXISTING DATk JOY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM - 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR - !
PITS AND/ORDRAINFIELD 2.00 STATION rte/ DEPTH
CESSPOOL—DRYWELL- !'
SPECIAL CONDITIONS ONLY 2.00 /�,[_��' MANHOLE REFERENCE
Up.RER L
TYPE OF CONIMCTION,"1 LENGTH FROM
OWNERS PERMIT $ I oD ' _y'_- CURS- P:L. M.L.TO P.L. ,
AUTHORIZATION TOTAL.FEE
1. HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
-CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TIJE PU.{{LIC SEWER ,
SIGNED THISNr D Y O ._..___. 19X:R NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..,,[-.-- --. __.. . :. ._.---.. ...._
BUILDING OR WORK
ry SEPTIC.TANK,SEEP..PiT(S)
ADDRESS ........ .. .�_ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT.I NAVE EAD THIS APPLI- CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
ALTER,REPAIR,SEWER OR
TO COMPLY WITH ALL COUNTY ORDINANCES AND'STATE LAWS
REGULATING PLUMBING AND SEWERS. — SEWAGE DISPOSAL.SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTEED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS. ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESC BED R IDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[:] CESSPOOLSj1d� �
OF PERMITTEE.` .. ........ ......_I ....
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