HomeMy Public PortalAbout10522 1/2 OLIVE ST_Sewer__ 34650 INSEA S
`6fi42D a
7bA5 RZD APPLICATION FOR PERMYT
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL y
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
Jc3I3N A. LAMBIE, County Enggineer
WILLIAM A. JENSEN. Sup't of Building LOCALITY "
NEAREST a
FOR APPLICANT TO FILL IN I CROSS ST.
LEGL
DESCRIP ION LOT NO. OWNER
BLOCK TRAcr ADDRESS
NO.OF BLDGS,
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP i PROCEs*#D BY
BKS P
CONTRACIORa
ADDRESS, y " ,,e CONNECTION DATA
CITY TEL.no. ioN ' i yu :,'��DEPTH
_> ,
- TATE MANHOLE REFERENCE -
REGIS7R_AT ION NO. ,,,; A,.'fi". L� COUNTY
NO. I DESCRIPTION OF WORK FEE
H?USE SEWER CONNECTING TO
Pc9BLIC SEWER (w $ .00 �-�-' TYPE OF CONNECTION LENGTH FROM 1
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TOP.L. y
PITS AND/OR DRAINFIELD
OVERFLOW SEEPAGE PIT.DRAINFIELD ;•.j ,f ,. f :�,;t „� : 9 -
EXTN..C-SSrOSL. DRYWELL
HOUSE SISCONNECTING TO J
P C.N0,
DIP
PR]VATE DISPOSAL SYSTEM @ $f�00 CO,IMP. NO.,/ f /'`� l06 NO, g„
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0 / '�/ � U
WORK TO HOUSE SEWER - "
AIJER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL a
CHARGES
OWNER'S I PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE f °'`;%.f REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. -
TRACTOR TO C.ONRECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS— DAY OF 19e NEW HOUSE SEWER _
OWNER OR / CONNECT ADDITIONAL -
OWNERS AGENT ylv BUILDING OR WORK
ADDRESS
SEPTIC TANK-SEEP.PIT(S)
— AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE 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 HOUSE SEWER
-CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCR19ED RESIDEN L PRO ERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE S.EE..PIT(S) ❑ ESSPOOLS ❑
OF PERMITTE
Ds 'VALMATION ROBERT A. WOOD
Etc
11.0. CASH SUPERVISING MECHANICAL ENGINEER
24656 INSERTS
CE808x-
75A6426 60 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION RutLD;NG ate' ,.�
ADDRESS
J01iN A, LAA[gBtE. County En
ginoer
WfLLHl A. TENSEN, Supt of Building LOCALITS;>
FOR APPLICANT TO FILL IN NEAREST
'GROSS ST.
LEGAL
DESCRIPTIONLOT N0. OWNER
BLOCK TRACT
MAIL
,A ;� �', ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO,
BUILDINGS - DISTRICT N0. GROUP MAP PROCESSI;df'BY
,.--` /- _�� BSC �' PCS _ "� ��i ✓
CONTRACTOR y a _ ,—�
ADDRESS ' „r;' y CONNECTION DATA
CITY TEL.N0. . ael ION ' DEPTH,;. '
z-
TATE MANHOLE REFERENCE UPPER
REGISTRATION N0. �° a "-COUNTY _
_ y z.
No, DESCRIPTION OF WORK FEE y
H01-SE 5 WEER CONNECTING To
PUBLiC SEWER $3.00 TYPE OF CONNECTION - LENGTH FROM -- --
SEPTIC TANK, SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. �1
ITS AND/OR DRAINFIELD @ S3.00 -
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.. CESSPOOL.. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO .- r P.G.N0.
PRIVATE DISPOSAL SYSTEM 51.00 CO. IMP. NO. ✓� f"-1� JOB N0. g.
CONNECT ADOIl'iONAL BLDG.OR ' b'_li tai
WORK 70 NJ s=SEWER @ $1.00 1 TRUNK PERMIT NO ROAD PERMIT N0. O0
ALTER,RIEPAiR OR ABANDON HOUSE :STATE:ENCROACHMENT Wd
SEWER OR D?SPOSAL SYSTEM @ $1.00 PER 41 if NO. }0}.
ft;" v j INDUSTRIAL W
_ _ WASTE APPROVAL P.
CHARGES
OWNERS PERMIT $ 2_ CONNECTION CHARGE FEE
AUTHORIZATIONTOTAL FEE `" 1 REIMBURSEMENT FEE
I HAVE THIS DATE A CONTRACT WITH THECON-
TRACTORATO CONNECT THE ABOVE DESCRIBEDIEXIISTIINGAMED DWEE,LLING APPROVALS DATE MSSPECTOR'S SIGNATURE.
TO THE PUBLIC SEWER.
SIGNED THIS. DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
----- /AND/OR DRAINFIELD
I HESEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE A€SOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL CJ
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE 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 HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNS. OF THE ABOVE —
DESCRIBED RESIDE AL PR ERTY. BACKFILL SEPTIC TANKS ❑
SEE PITS) ❑ CESSPOOLS ❑
SIGNATURE ;
OF PERMITTE ;. > 7' = •ri
gE VALIDATION ROBERT A. WOOD
CK. m:.o. CASH SUPERVISING MECHANICAL. ENGINEER'
4