HomeMy Public PortalAbout10535 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEIA/ER--SEWAGE DISPOSAL
-•DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION ® � 1
COUNTY OF LOS ANG=8 _ c�.t331
.
+ rr WILLIAM J. FOX, COUNTY ENDINEER BUILDIPIO _ �+ J
� _ ADDRESS _ C_JL�.(�
. dS6 RNIT TO ILL IN LOCALITY
BUILDING NEAREST
ADDRESS � ,� i CROSS.ST:
LOCALIT. a DISTRICT NO. 99RIAL N0: PERMIT N0.
NEAREST _ A r. / 5- A ���/� S
CROSS ST.e__ . Y/• �L � .
RE/QEIVED BY Ready for Inepeotion' DATE-ISSUED .
OWNER
%MAIL
ADDRESS Y / 'I -Q• USE ZONE OCCUPANCY' MAP
I
CITY - - TEL.NO: BK PG. .` '
CONTRACTOR -(f,$ZifO.rnl$ Sewer Const,CO CO.IMP.NO. ` / 549'
ADDRESS 1317 -Colegrove Ave. JOB.NO.
CITY -Montebello TEL.NO. UNj,aII 1a13O48 TRUNK PERMIT NO. `
REGISTRATION NO.- 104445 TATE
[� )�,��y.• � 14iTY ROAD PERMIT NO.LEGAL
DESCRIPTION LOT NO.! d"/y - L/ 7, 1 STATE.ENCROACHMENT
h PERMIT NO.
BLOCK TRACT A 67 io _ INDUSTRIAL
OVAL
S12E OF LOT i�c� L �q t NO:OF BLDG!;; -
1d�L A t+[ �./� NOW ON LOT , CHARGES-
USE OF
BUILDINGS _�� . CONNECTION CHARGE FEE
NG. DESCRIPTION OF WORK "FEE
HOUSEREIMBURSEMENEE
.SEWER CONNECTING TO /` /
PUBLIC SEWER QD S _3.50 !✓ RECEIPT NO. DAT IBY
HOUSE SEWER CONNECTING TO
PRIVATE.DISPOSALSYSTEM I.00
CONNECT ADDITIONAL BLDG.OR - q EXCEPTIO �E�
NCORDED
WORK TO HOUSE SEWER 1.00 h NO.
ALTER.OR REPAIR EXISTING ATE I BY
SEWER OR DISPOSALSYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONN9CTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRA'INFIELD- 2.00 STATION /�- q b,6 DEPTH "
CESSPOOL—D..RYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANH�OLE�REFERENCE
�� a _ w C� -I OWER
- TYPE OF CONNECTION. LENGTH FRO / f
-Y GUfm_CONNECTION
M.L.TO P.L. S
OWNERS PERMIT $ Oo --
AUTHORIZATION
TOTAL:FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN 'NAMED
CONTRACTOR TO CONNECT THE ABOVE DYESC EXISTING APPROVALS INSPECTOWS SIGNATURE ',DATE
DWELLING TO THE ;BLIC SEWER
SIGNED THIS �.DA OF, __ Iq NEW HOUSE SEWER.
OWNER OR f __ CONNECT ADDITIONAL
f... - BUILDING OR WORK'
OWNERS AGENT.-....
*� SEPTIC TANK.SEEP..PIT(S) _
ADDRESS...... .... . AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ-THIS APPLI- CESSPOOL D ORYWELL 0
CATION AND STATE THAT THE ABOVEIS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR..SEWER OR
REGULATING PLUMBING.AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY .CERTIFY THAT I AM PROPERLY. REGISTERED
AND/OR LICENSED AS REQUIREDBY BY LOS ANGELES COUNTY D18CGNNECT PLUG AND. -
AND STATE OF CALIFORNIA OR THAT 1 AM THE. LEGAL OWN. ABANDON.HOUSE.SEWER
E81-R OF THE ABOVE DESC IBED E8IDENTIAL PROPER BACKFILL SEPTIC TANKS a r ry
8EEP.PIT(S)[3 CESSPOOLS®
OF
/ .y Ja `
OF PERMITTEEG/J.�C B .. -.: .--•• --.._ .. ..:�.._....... - -
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