HomeMy Public PortalAbout10545 OLIVE ST_Sewer__ y
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'6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F
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IQIN P'e, LdLF/1BI�, C®untg Engineer SS � ,......
WILLIAM A, IMSEN. Supt of Building
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:-lOII APPLICANT TO FILL IN CROS ST - -
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NO. OFBOGS— - � _L
NO
'Z€ O.' LOT N'OW O.N L O'T CITY TEL, NO.
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_CONNECTION
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A-ZREGIS RAT IJN 7 COUNTY MANHOLE.REFERENCE
NO. DESCRIPTION OF W K PEE
TY PF OPGOd NFCTftd'N LENGTH FROM
G Y- L. ML TO..L.'DJ.E_SEWER CONNECTINO
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uBL,1e SEWER
PI S AhD 4 LRAINFd EL D i $10,00 CO IMP,NO. zt-__.,cJOB NO
O C SEW R2 CON NkC ING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00
- _._ _— - _
f h'^d Nd:Ci A JITIONA BLDG Ok -AFFIDA VI7�wAdYlk l.44EMEhT�1, FEC ORD.INSTR.NO� DATE
WORK TO HOU SEWER Cbz SS.00 I I
U�f RF LDNr 5 EPP E RIT ORAINF FLD -1_._.- f ------L.--.—
E'rTh CE POOLED YWELL.MP NHO,-E @ $5.00_ HWY.OR 57.WdDE;NTNG
ALTF.2. FPAli2 OR ABANDON H-CrUSE
I
YJ[ JR SPOS SYSTEM (Lil $3.00 ST'TE tpdC ROACHM NT -
7t PERMIT NO
INUliS7RiAL.. _`v
WASTE APPROVALf
OWNER'S PERMIT 51 -- - --- -- --- - -- -
AUTHORIZATION TOTAL FEE s t+{ � CONN[ TION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH 'THE HEREIN NAMED COPD- REIMBURSEMENT FEE
TRACTOR TO COY NECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLi SE.YER. L'LPCLIOVALS I GATE IIINSPECTOR'S SIGNATURE
SIGNED THiS_._ DAY OF—_
OWNER OR NEW HOUS E SEWER
OWNERS AGENIC`___ �.._. _ _ ---_.._.... CONNECT ADDITIONAL
BUILDING OR WORTS
ADDRESS o-_
SEPTIC TANrt SEI PITS) I
HF EBV ACKNOWLEDGE THAT HAVE REAL) THIS APPLICATION AND/OR DRAINFIELD I
.AND STATE THAT TH.E ABOVE 15 CORRECT AND AGREE TO COMPLY —_- -_.- -._--_..- I- _.__.�
'lV iTH ALL COUNTYORDIN'A.N C ES AND STATE LAWS REGULATING
PLUMB'NG AND SEWERS CESSPOOL DRYWELL ❑ '
IHEREBY `..ERTiFY THAT I AM PROPERLY RE'UTSTEREO AND/OR ALTER,REPAIR,SEWER OR
LICEN3;>D AS REO TIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL;F 1FNIA OR THAT' I AM rHE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND _—Iy -- - '---_ --
RESIDE N. THE A E DE>GR-18ED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER I
SIGMAT
OF P U'Rk5. TE -+E` -,rte°-- _.-- Irl 3'tiZ�' BACKF! L SEPTIC TANKS 7
--- SEEP.PITS) Q CESSPOOLSI
yVALIDATION ROBERT A. WOOD
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CKM.O. CASH SUPERVISING MECHANICAL ENGINEER
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APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FN
ILDING
DRESS
Jflllrii A. L14F+`TEIE., County Engineer ---
tFf%XLI�iR3 A. J£PZSEN, $L) '4 0# Building ,��!' p - -- _----.—CAL1"I'Y
ARESTFOR A FLICANT TO FILL INOSS ST
?V'„' ',T NO OWNER
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MAIL
BLOCK _-TRACT � ADDRESS _
NO. OF BLDGS. s9
.r_ OF ;.OT - NOW ON.LO'T' � CITY- TEL. NO.
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TRICT NO. GROUP MAP PROCESSED BY
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ADDRESS , P CONNECTION DATA
CITY y T70N ✓y J� ( rf DEP N47
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_TE NO.
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T'ATMANHOLE REFERENCE
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R'G;CTRATtON 'Ft O. 9 OU i �tGW ER
NO. t DESCRIPTION CT' WORK FEE TYPE OF CUNftF TfQP-0 LF.NGTS FROM
LOUSE SEWER CONNEC.tiNG TJ .0 M.L TO P.L.
- PUB IC SEWER @ $s.0oPLP C.NOSEFtIC TANK,SEEYAGI.PIT OR IMF tJO. JOB NO.
_ FITS AND!OR DRA!NFIEt,D @ $!0.ObPRIVATE; _- -HOJSLSEWFr'CONK l lNG TONK PERMIT NO ROAD PERMIT NO,C •i. f D! P05AL 5(&TEM 4 $ .OQCONNE.:'ADDITtOA.ALIDAVIT WA{YER E.45EMENT RECORD.INSTR NO. DATE
- riOUSE SEWER $3.00 ! - a�'g
OVERFLOW EEPAGE PIT,DRAINFIELD
----- --1--- - - -- - - - . -- - --
EX N,CESSP OOL,DRYWELL.MAN OL.E @ $S.00 HWY. OR uT.WIDENiI�dG
ALTER,REPAIR-OR AD
BANON NOUS$. -- -��--
SCf<`ER C DISPOSAL SYSTEM. @ $3,00
__-__--_---__. - STATE ENCROACHMENT
PERMIT NO -
INDUSTRIAL "
WASTE APFROYAL
OVMER'S PERMIT CHARGES
2i-00-
CONNECTION
_. CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH. THE HEREIN NAMED CON. REiMBLRSEM EN7 FEE
TRACTOR TO CON NETT THE ABOVE DESCRIBED EXISTING DWELLONGqy-.._-__--____
TO -:'HE. FUet.C SEWER. APPROVALS DATE f INSPECTOR'S SiGNATURIE
DATE
SI GNE:3 TH!a__--.._.M1_•hY OF-----I 9
OWNIR OR NEW HOUSE SEWER
_._-_
OWNERS.AGENT-_- _-_-__-_-._-_�_____,..___. .-______-- CONNECT AO[)iTIONAL. I
A.UL;REti BU I LDi NG OR WORK
SEPTIC:TANK.SF_EY',FIT(S)
1 HFR'c8Y ACKNOWLEOVE THA, 1 HAVE HEAL) THIS APPLICATION AND/OR URA!PIF',ELD
AN 5 TE THAT THE APOVE IS CORRECT[ AND AGREE TO COMPLY
P1TH A_L COUNTY ORDINANCES AND STATE LAWS REGULATING I --
PLJMBIN.3 AND SEWERS,
CESSPOOL L DRY WELL
I HEREBY CERTIFY THAT i AM PROPERLY 'RFG TERED ANO/OR ALTER,RE AIR,SEWER OR --�- ----j ---- -
L1:�cNSED AS REQUIRED BY LOSS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM II
CA L!FORNIA OR TF10.T i AM THE Ei,Ai. OWNER OF, AND INTEND TO PLLJG AND
RESIDE N, TRE VE DFSCRiABANDON HOSE
SEE) RESIDENTIAL PROPERTY. _ I I
USEWER
SIGUNATE '^
O." P.'RM i Ti-EE. � - •,T ._ _ BAC.KVILL SEPTIC IANKS [] [I!
SEEP.P!T(_,) [� CE55POOLS
VALIDATION ROBERT A. MOOD
cK,, M.v. CASH SUPERVISING MECHANICAL ENGINEER
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