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HomeMy Public PortalAbout10527 OLIVE ST_Sewer__ 7 �1 6?5 6420 APPLICATION FOR PERMIT ' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONIt NG e, JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of Building 'It NG -1 F�.RF LOCAL'TYs NEARE 'r. ST , 11 FOR APPLICANT TO FILL IN CR 0.15 DESCRI P I T-11.4 -,,o-r NO. OWNER MAIL BLOCK PACT ADORES- NO 0 F 84.0 GS. SIZE Of` LOT 0W 014 LOT tin CI7yTEL, NO. _ USE 0DISTRICT NO GROUP .MAP PROCESSED 13Y BIC PG c. CONTRACTOR ADDRESS CONNECTION DATA C �ZT, TION DEPTH TEL No. CITY STATE MANH OLE REFERENCE/" REGISTRATION No. COUNTY N07---_HsCRIRTION OF WORK FEE TYPE OF C04NECTION "LENGTH FROM HOUSES��WER CONNECTING TO M.L.TO P.L.Y, PUBLIC SEWER @ SS.OD P.C.NO. CO,IMP.NO. JOB NO. 0 PITS AND/OR DRA!NF'IELD @ $10.00 _T iNt,TO------__-- — J TRUNK PERMIT NO. ROAD PERMIT N PRIVATE DISPOSAL SYSTEM @ $3.00 1 7 CONN ECT ADDITIONAL SLOG,OR FIDAVI I wA;vER 1 5 NO, RK TO H.?' SE SEWER @ OVFRFLOW SEEPAGE Pi[T,DRAINF;ELD ------- w EX-;-N,,CESSf OOL.IDRYWFLL.NIANIOL�E: $5.00 Hwy� 0, ALTER,REPAIR OR ABANDON HOUSE I S P 5 A L 5 YS 7 EM _--STATE ENCROACHMENT PERMIT NO T-__--I._.____.__, INDUSTRIAL WASTE APPROVAL. CHARGES OWNER'S PERMIT MIT 21 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNEC"! THE ABOVE DESCRIBED EXISTING DWELLING. -r- TO THE PUBL:C SEWER, APPROVALS DATE I f145PECTOR'S SIGNATURE: SIGNED THIS_—DAY ------ OWNER OR NEW PCIUSr SEWER OWNERS AGENT—.--- CONNECT ADDiTIONAL SUI LD'i NG OR WORK ADORESS___= ....... SEPTIC ... TANK.SEEP,PTT(S) I HEREBY A-KNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO,OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH f,,LL c'OJNTY ORDINANCES AND STATE LAWS REGULATING Mr CESSPOOL El ORYWELL PLIJ MH ING AND SEWERS - HERERY CER'TIF'Y THAT I ASI FROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LI CEN5EDAS REOUTRED BY LOS ANGLES COUNTY AND STATE OF SE.WAGF DISPOSAL SYSTEM CAA iFORN IA OR THAT I AM THE LEGAL OWNTR OF. AND INTEND TO D"ICONNE P!_UG AND RU S DE THE ABOVE D KTIAL PROPERTY. AEANDON HOUSE SEWER S!GNATUR E 7AC'KF.1LTI_'SEFP❑T TANsKSSP SPOOLS OF PERMIrTEE I VALIDATION � ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH 6A642D APPLICATION FOR PERMIT c COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 4 i DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FZNEAREST LDING � p �� -- j _ t TOHN A. LAMBIE, County Engineer REs I >-_--- WILLIAM A. IENSEN. Supt of Building /. ALiTYFSS T. FOR APPLICANT TO FILL IN --------- t //'� Y: DES CR P SON LOT H7 t Yi L' ,€ .�,- _ _ OWNER _/_'Q _ MAI' --- - '- SLOC'K TRACT a,./i� ! I / j ADDRESS NO. OF SLOGS. p 5.12E OF LOTNO`N ON LOT ±; CITY TEL, NO- USE O.U F OF ._ BI ILDING'd' 3 5, — rJlS'TR!r'.T NO, fl Rt)UP MAP F'ROCC Sy:O 13Y K PG CON'I*RACTORi c ADDRESS1,4CONNECTION$�-z.- ���--�, �' ----^_--- �;; -- CONN CTION DATA DEPTH TEL NO. �s '-' �e ", - �i - % X } C? ❑ STATE MANHOLE REF£RE YCE STRATIWN NV ,F T k+` (N j. LOUNTY Tsdpq. Pfb.,,I DES PT° CRI1 ON CDS WORK— FEE -.-.._- TYPE QF C;O�NNECTHON L N01H FROM ) .' _ HOUSE SEWER ^. ...0NinE71S+iG TO Y li.�.,',CpR,�i.J' P.L. M TO P.L. PUBLIC SEWER G $5,00 ---.__ _- —_—__ 140. --_---.. ,.--.— f� P C. O. SEPTIC TANK,SEEPAGE;'17 O"+ PITS OR . - X n $10.00 CO.IMP NO'YJ_'--p JOB td C+. - D, ORAiNFIELD �� � I _..-- -- � HOUSE SEWER ONNE TING;TO .PRIVATE.DISPOSAL SYSTEM @ $3,00 TRUNK PERMIT NO. ROAD PERMIT (_O:N NECT FDL''T=ONAL BLDG-OR AFFIDAVIT ! WAIYEX EASF>.lE4Y RECORD.!NS TP r{O- GATE v�OH'rC TO O ISE SEWER ( 83.00 04 KRF WOW SEEPAGE PI r,DRAIN FIELD EXTIN,C E'SS{OOL,O RY W'k't_L;?✓ANf-.OLE.@ $:5.00 [,� __ _ _.__ HWY.O $T"NY I NTNG 44'1 ER,R FAIR OR ABANDON H— LT E �— .. _-- R ©E .-_ .!. EJY.,:R br2 O 5PC$R SYSTEM @ $3.00 *�-.- _�___-.._ STATENCROACHMENT 4.,r !' hf PERMIT NO.F_ --- WASTE APPROVAL CHARGES OvvmR`S PERMIT + o - - - - ---- -- ----- ---- � CONNECTION CHARGE FEE AUTHORIZATION TOTAL FE£ -'- ---_. - - --- - -- .-------- '1 HAVE AT THS IS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLIPV i .— -- .__ __ ._...--___..-_. APPROVALS T TO THE PUBLIC SEWER. DA'T'E INSPECTOR'S SIGNATURE SIGNED THIS_ DAY QF---'--`—'---- —`g-- ---- - ------._..--- --..=---'-- OWNER OR NEW HOUSEEWER _ OWNERS AGENT__ COrSN ECt ADDITIONAL ADO^-R ESS B-.LDING OR WORK t .`:PRIG TANK SEEP,PIT(S) I ! HEREBY A=KNOW!.,.E'7C£ rHAT' 1 HAVE READ THIS APPLICATION AND/OR DRA€NFIt_D AND TP E_ THAT THE. ABOVE IS CORRECT AND AGREE TO COMPLY V✓ iTH ALL �� ORDINANCES AND 'MATE. LAWS Ri_GltL4TiNG OUNTY PL•J MBiN, AND SEWERS. CESSPOOL. Cl DRYWELL. ❑ I i HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED.BY LOS ANGLES COUNTY AND STATE OF S EWAGE DISPOSAL S15TEM � CAI IF'ORN!, OR THAT t M THE LEGAL OWNER OF, AND INTEND 70 --- --'—"---_—}-- ---"—F--'---- —"--'— D13CONNECT PLUG AND ' R=ESIDE. IN, 'THE ASCA,Y F_ pESC:FdlBEO RES!kiENT!A l.. PROPERTY. 1 w ABANDON HOU E,SEWER SIGNATURE `s:s OF PERMITTEE �„ � t f BACKFILL SEPTIC TANKS ❑ i � - SEEP,P. (S. ❑ CESSPOOLS [J! 1 t VALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG!NGER - l