HomeMy Public PortalAbout10531 OLIVE ST_Sewer__ E80"10-63
bAf 42D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION S�J!LD ING
ADCRESS
JOHN A. LAMBIE. County Engineer
WILLIAM A. JENSEN, Supt of BuildLag
LOC.L.Ty
FNEA�S REST
T-
�_�ROS
FOR APPLICANT TO FILL IN
-LEGAL
DE:sc�l PI I oil LOT NOD, f OWNER
A
17 " " MAIL
BLOCK TRACT ADDRESS
NO, OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF' DISTRICT NO. GROUP
BK MAP PG PROCESSED.BY
BUILD NGS
CONTRACTOR
ADORrSSL CONNECTION DATA
STATIONDEPTH
TEL.
STATE MANHOLE REFERENCE Y
FTF!IE�i AATOMCOUNTY
NO , CESCRIPTION OF WORK FEE TYPE OF j?NNE
dTION NGV H FROM
0 M
—
NE —
HOUSE SEWER CONCTO Y" EP.L. M.LTO P.L.
PUBLIC SEWER $5.00
P.C.NO.
OR Co.IMF,.40. JOB NO.
PITS AND,OR GRAINFIELD
HOUSESEWPP.CCNINECTINGTO TRUNK PERMIT NO. ROAD PERMIT Nt%/
@
PRIVATE DISPOSAL SYSTEM
. .
C�)NN E G T ADDITIONAL SLOG.OR AFFIDAVIT WAI�'E EAsim—VNTRECORDINSTRNO. DATE
WORK TO HOUSE SEWER
EXTN_CESSPOOL.DRYWEIL.MA 11 HOLE @ $9�oo 1 ZL_
HWY,OR ST.WIDENING
ALTER,REPAIR OR ABANDON HOUSE
a $3.00
SEWER OR DISPOSAL SYSTEM STA FW-136ACHMENT
1A PERMIT
iNDUSTRjA;_
WAST X0�,R3�\(Ak
CHARGES
OWN]WS
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE. A CONTRACT WITH THE H NAMED CON, REIMBURSEMENT FEE
T HEREIN
TRACTOR 70 CONNECT THE ABOVE: DESCRIBED EXISTINGDWELL ING —T DATE
TO THE P UBLIC SEWER. APp &VALS INSPECTOR'S SIGNATURE
SIGNED THIS__DAY OF
OWNER OR
NrW HOUSE SEWER
OWNERS AGENT____'L_� CONNECT ADD,TIONAL
13 LOING OR WORK
ADDRESS--------
SEP T:C TANK,SEEP. PIT($)
I HEREBY ACKNOWLEOGE THAT I HAVE READ THIS APPLICATION ANO/OR DRAINFIEl-D
AND STATE THAT -HE ABOVE 15 CORRECT AND AGREE TO COMPLY —------
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
N Il IMB A LL C
-
WITH CESSPOOL ❑ DRYWFLL
PLU ING ANC SEW RS
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Al_TFR,RE PAIR,SEWER OR
Ll C ENSED AS REQU;RFD BY LOS ANGLES COUNT' AND STATE OF 5"WAGE DISPOSAL SYSTEM
CALIFORN A OR THAI I AM THE LEGAL OWNER OF, AND INTEND TO 6 CC�N CT G
I P AND
T
_S
ESiDE �N, THE ABOVE. D)ESCRIBED RES ENTIAL PROPERTY. A�IANDON HOUSE SEWER
SIGNATURE
BACKFILLSEPTIC TANKS
0 OF P EP.IT, ——----- SEEP.PIT(S) [I CE55POOL5 F PeRMITTEF-
VALIDATION
ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.0 CASH
E80'3.
10-63 ell
8
6 A%42 D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES d
DtPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL d'
BUILDING AND SAFETY DIVISIONBUILDING
C RES
JOHN A. LAMBIE, County Engineer AD
WILLIAM A. JENSEN, Supt of Building
LOCALITY t
NEAREST 7
[CRfi
FOR APPLICANT TO FILL IN OSS ST.
E:gAl- g
D ES _OWNER
CRIPFION .c,r N O
MAIL
BLOCK :T A.R'ss
NO. or BLDG'S.
_SIZE OF L.:7T N�,W_ON LOT CITY TEL. NO.
UaE OF
DISTRICT NO: GROUP1 MAP
ILO NGS S BK PG PROCFS
ST
x
CONTRACTOR
ADDRESS vN
c" CONNECTION DATA
STATION ..DEPTH
C I T Y v Tf�' Nb.
REGISTRATION N
-STATE MANH OLE REFERENCE ........
0 COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FRO
HOUS SEWER CONNECTING TO CURB P.L. TO P.L.
-- ---- -- ---------- ----T----� I ,�' Y
PJ PL[IE 5 EW E R 0 � - ! ,
$S L- 'i �, " P.C.NO,
P I;, CO. IMP. NO,_
2 --SEPTICT-ANK-SEEPAGE - OR J013 NO.
PITS AND/Of?DRA(NFirl.0 @ sl(00
____H&7 SE TRUNK PERMIT NO, ROAD PERMITNI;�'/-
0 SEWER CONNECT!NG TO
PRIVATE DISPOSAL SYSTEM' @ S-'i.00
v EASE.ENT F� NO,
I CONNECT ADDIT)ONAL EILOG.OR AFFF15�VIT�A —ca, RD TW� DATU
WORK TO HOUSES WER@ S3:00
-OV F IiF LOW S�-E FA G E PIT,GRAIN F I E Lo
I7,XTN..CESSPQOL,DRYWELL,MANHOLE: 55.00 1
RF PAIR HWY.OR'Sl WIDENING
ALTER,--F ----VB�ANDCN USE
SEWER OR DISPOSAL SYSTEM @ $3.00
STATK.EIN-ROAC_FOMENT.
PER
wc
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 21 00 ------
AUTHORIZATIONI -TOTAL FEE CONNECTION CHARGE FEE
REIMBURSEMENT FFE
I HAVE AT THIS DATE A CONTRACT WI-H THE HEREIN NAMED CON-
TRA C OR TO CONNECT THE APOVE DESCRIBED EXISTING DWELLING
P I APPROVALS -;IC
TO THE UH-Ic SEWER, DATE INSPECT C AZURE'
SIGNED THIS-DAY
NEW HOUSE SEWER
OWNER"'R
OWNERS AGENT.—___— CONN E:c-r-A—DDI T-1-0-NA-—L
BU I LDING OR WORK
TANK�SEEP,P-1-1
A
SEPTIC;
I HERESY ACKNOWLEDGF THAT I HAVE READ THIS APPLIIZArION AND DRA,NIFIELD
ANDSTATE THAT T�F ABOVE IS CORRECT AND AGRFE. TO COMPLY
T
I
U
TRAW
A DURESS_
WITH ALL COUNTY ORDINANCES AND STATE LAWS RFGUL.AT!NG
PLU M 5 ING AND SEWERS. CESSPOOL Cl ORYWELL F1
t HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
Lt TATE OF SEWAGE D15FOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGLES OQUN,'Y AND S
-SCONWECTT PLUG AND
C
REDID_AL�FORN I A OR THAT I M THE LEGAL,�OWNER OF, AND INTEND TO
R -ENTIAL
ES OF iN -rHr. ASOVF�DESCRIVEOI�HILSID PROPERTY. ABANDON USESEWER
Arl'ILL,SEPTIC T�
SGJNATU RE %NKS di
IF TTEE
SEEP,PIT IS} CESSPOOLS
`,VALIDATION ROBERT A. WOOD
C K. M.O. CASH. SUPERVISING MECHANICAL ENGINEER