HomeMy Public PortalAbout10536 OLIVE ST_Sewer__ TEMPLE CITY
OAS42D APPLICATION FOR PERMIT - -
F808 8.58 - 7
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAME. County Engineer ADDRESS
CASSAIT D. GRIFFIN, Supt of Building LOCALITY -
NEAREST r
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL 6.r.•
DESCRIPTION LOT NO. QWNER
BLOCK TRACT MAIL
ADDRESS
N0.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY7e le �/; TEL. NO.
USE D
BUILDINGS v y DISTRICT NO, GRO MAP PROCESSED BY
BK PG ✓
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL.NO. STATION DEPTH
❑ STATE MANHOLE REFERENCE ZIPPER
REGISTRATION NO. ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB, P.L. M.I.-TO P.L.
PITS AND/OR DRAINFIELD @ $3,00 _
OVERFLOW SEEPAGE PIT,DRAINFIELD ff., � 1.� �" +
EXT
.
,CESSPOOL.DRYWELL @ $2.00 P.C.NO.
HOUSE SEWER CONNECTING TO CO,IMP,N0, JOB N0.
PRIVATE DISPOSAL SYSTEM - @ 1.00
CONNECT ADDITIONAL - ➢
ORK TO HOUSE SEWER (Ta-i00 TRUNK PERM-1T N0. ROAD PERMIT N0.
W '
ALTER, PAIR OR ABANDON HOUSE STATEENCROACHMENT
EWER ORREDISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE <) 07,41-,° REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE I NSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 79— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL -
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
PLUMBING AND SEWERS, ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUJITY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNFR OF THE ABOVE
DESCRIBED RESIDENT L-PROPE BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTE
9r VALIDATION _ ROBERT A. WOOD
CL Y.o. CAST[ SUPERVISING MECHANICAL,ENGINEER
LALxo
l
. 6$fl•fi5
3&E.6 6G - APPLICATION FOR PERMIT
3&[
DIVISION OF BUILDING AND SAFETY SEWER-SEWAG DISPOSAL
Department of County Engineer
County of Los Angeles 3UILDING _
JOHN A. LAMB.IE, COUNTY ENGINEER _,S.DDRESS — _ ---`--- -
,3 b
CASSAT7 D. GFtiFF1P;, SOP'7 of BUILDING !_OC.ALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO, OWNED
BY
diOCd /�:. TRACT PDDRESS
SIZE OF LO7 NOW ON LOT '. CITY _. TEL NYS ,� `7"
:7
-.r
USc OF
6U.L7 N1 GS �, DISTRICT N0. GROUP MAP
BK PG
CONTRACTOR d
"` -- - -
ADDRESa
CTIOId DATA
CC
CITY "91,. E TEL. NO. `/. ° ;6. V.TATICN —_ �f '._- C_c".-DEPTH
MANHOLE REFERENCE �ep
k ' STATE
_ _ ----
REGISTRATION "SO -..> _} ']' COUNTY
NO. j DESCRIPTION OF WORK FEE ---
j TYPE OF CONNE.CTI�y `1 LrNGH FROii.. _ —
HOUSE SEWER CONNECTINGTO
erg_ PUBLIC SEWER _ @ $3.50 ---`. ---GURd P L. _ A.L . 0 P L=-�---w ---
SEPTIC TANK,SEEPAGE PIT OR I
PITS AND/OR DRA114FIELD fir .$3.00 -
OVERFLOW SEEPAGE PIT,DRA NFIEL D � � f P C No,
EXTN.,CESSPOOL,DRY'AIELL,MANHOLE (w $2.00 1 I CO. Imp. NO., � — lOR NO.
HOUSE SEWER CONNECTING TO
_ ! PRIVATE DISPOSAL SYSTEM------ qv $1_00TRUNK PERMIT NO, ROAD PERMIT NO.
CONNECT ADDITION L BLOG:.OR ----__—_-----__.----
I STATE ENCROACHMENT1
--
WORK TO HOUSE SEWER (ril $1.00 j„ —' PERMIT T70..
ALTER,REPAIR OR ABANDON 40LISE (.._ -- -- -----------. _.---
SEWER OR DISPOSAL SYSTEM. ir: $.9.GG ! ! INDUSTRIAL
VIASTE APPRCVA.L _
CHARGES
_--j------------------ ---------�-----
CONNECTION CHARGE FEE
w
OWNER°S PERMIT 1 00 —--- -------— --— — _—
AUTHORIZATION TOTAL FEE i y - REIMBURSEMENT FEE
s INSPECTOR'SSIGNATURE
APPROVALS DATE ;
:L,Vt A; THIS DATE A CONTR:AC"f WITH THE HEREIN NXME CON• ___---- .----------__—.L. ---.--.—,:
tP_ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
TO THE PUBLIC SEWER, NElV HOUSE SE'MV,G,'Ci
SIGNED THIS DAY OF ,--- ID CONNECT ADDITIONAL
OWNER ORBUILDING OR WORK
OWNERS` AGENT— ,r:�. - ---- �-- ---- - ------`-------------- --
f,EPTi„TA.NK,SEEP,PITS)
ADDRESS AADf OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAI I HAVE READ THIS APPLICATION CESSPOOL,,..I DRYWELLCI
AND STATE THAT THE ABOVE IS CORRECT AND AGREE 10 COMPLY
WITH
._�-----------,-_-----
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM !
PiEREBY CERTIFY THAT I AM PROPERLY I IZGWERED AND/OR t''ISCOYJ i`dEL'T PLUG�kNO 1.�--
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF —�---------- --'---
CALIFORNIA OR THAT I AM THE !,;G/IL OWNER OF THE ABOVE —K-BANDON HOUSE SEWER -
DESCRIBED RESI-DENT 14L:-PROPERTY, a BACKFILL SEPTIC TANKS L;
SEEP.PIT(S) i,_I CESSPOOLS",:3
SIGNATURE —__... --------- .---
OF PERMITTEE,s� - 't Y►.; r 4 P..�.: _ ''l - j.
laHTv A. LAMBIE, COu"Wry ENGINEER G tI.IDATI ROBERT A,WOOD, CH- EF PL BG. INSPECTOR
F 6K. X O. CASH -