HomeMy Public PortalAbout10530 OLIVE ST_Sewer__ APPLICATION FQI PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADD Ess
JOHN A. LAMBIE, CoulAy En lases _
GASSATT D. GRIFFIN, Sup t d�usld4 LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. Z
LEGAL f #
DESCRIPTION LOT N0. _�% �" '-,.'�?. ,' j�:: OWNER f.' 4t If -gin ��
#._
BLOCK TRACT i MAIL s !
_i .
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY ', TEL, NO.
USE OF'
BUILDINGS �-Z@ Io DISTRICT NO. GROUP MAP PG
BK
l O ESSED tiY
CONTRACTOR Able Constr. fir.; �ry � ;l
ADDRESS 225 W Bryant Rd. � _ CONNECTION DATA
-CITY El Mont g TEL.NO. G,i 8� STATIONS DEPTH
168579
® D STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. .+ /` [] COUNTY �
� IOWE£k:_.'
NO. 0 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3,00
SEPTIC TANK,SEEPAGE PIT OR $, TYPE OF CONNECTION LENGTH FROM
`Y.Ir
PITS AND/OR DRAINFIELD @ $3.00 ,.CURB P.L. M.,L.TO P.L.
.OVERFLOW SEEPAGE PIT,DRAINFIELD ^r
E7C7N.,CESSPOOL. CRYWELL @ $2.00
HOUSE SEWER,CONNECTING TO CO.IMP.N0. P.C,NO.
PRIVATE DISPOSAL SYSTEM @ $1.00
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT NO. � -
WORK TO HOUSE SEWER @ sl.00 ,i
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM C $1.00 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEWS PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION T®TAL FRR a ;d REIMBURSEMENT FEE I
I HAVE AT THIS DATE A CONTRACT 'WITH THE' HEREIN NAMED CON- APPROVALS I DATE C
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING INSPECTOR'SSIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS - DAIC NEW HOUSE SEWER
OWNER O.R ,A. ;p a CONNECT ADDITIONAL
OWNERS AGENT '' BUILDING OR W'OP.K
ADDRESS. SEPTIC TANK,SEEP.PITS)
_------ AND/OR DRAINFIELD
I HEREBY. ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPODt El DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY' CERTIFY THAT :I AM PROPERLY REGISTERED AND/OR � SEWAGE
DISPOSAL SYS
LICENSED AS REQUIRED BY/LOS ANGELES BOUNTY AND STATE OF DISCONNECT
ISONABANDON CTUSEGAND
CALIFORNIA OR THAT I M THE LEGAL OWNER OF THE ABOVE —
DESCRIBED RESIDENTIAL PIROPFRTY, BACKFILL SEPTIC TANKS (�
SEEP. PITS) C✓J CESSPOQL.S E3
SIGNATURE ✓ f"
OF PERMITTEE �� �I'�"`.�..
'F VALMATION
ROBERT A. VI/C90D
(CK, M.q. CASH SUPERVISING MECHANICAL, ENGINEER
.•A
X 64-a APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building LOCALITY 7-/-- <
T
FOR APPLICANT TO FILL IN NEARES
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL :
6, 6
NO.OF BLDGS. f -I
SIZE OF LOT NOW ON LOT CITY /,/4- TE NO.
USE OF DISTRICT NO.I GROUP MAP POCESSED,-BY
_RUILDINGS
ji
CONTRACTOR mur IT I B
ADDRESS 225 CONNECTION DATA
CITY TEL.NO.Gi 8- STATION PEP H_�,
Monte 6565
STATE MANHOLE REFERENCE -U-PPEER
_MT�LTPA*��I�N NO. 168579 COUNTY
NO. `DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
ER $3.00
--±—UsLICsEwEf-- TYPE OF CONNECTION --LE1tGTff,*rROW-
CITY
CITY
DISTRICT NOO
T
S T ONE
TA
ST TE 0L E
MAN
COUNTY
I'D'
TYPE
Y—c
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAfNFIELD @ S3,00 CU-,RB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DPAINFIELD
EXTN..CESSPOOL.,DRYWELL
HOUSE SEWER CONNECTING TO C.NO,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO, 013 NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO, ROAD PERMIT NO.
WORK TO HOUSE SEWER @ 51.00
ALTER, REPAIR OR ABANDON HOUSE STATE,ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1.00
PERMIT NO.
INDUSTRIAL
r 7 WASTE APPROVAL
CHARGES
OWNEWS PERMIT $ z- 06- CONNECTION CHARGE FEE
AUTHORMATION I TOTAL FEE j
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE MSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THISDAYOF-19—
NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL
OWNERS AGENT--- BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP.PIT(5)
TANK,
AND/OR DRAI
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT,THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL El
WITH ALL.
COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT .1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY/LOS ANGELES COUNTY AND STATE OF ABANDON HOUSES EWER
CALIFORNIA OR
THAT I THE LEGAL OWNER OF THE ABOVE
I A�I,�y
DESCRIPED RESIDENT OPEPTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP. PITS) CESSPOOLS El
Or PERMITTEE
--VALIDATION ROBERT A. WOOD
CK N.01 CAS11 SUPERVISING MECHANICAL ENGINEER
r.
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