HomeMy Public PortalAbout10555 OLIVE ST_Sewer__ E808 10-63
6 A 642 C) APPLIdATION FOR, PERMIT
COUNTY OF LOS ANGELES :1 SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BU I LOING
X
JOHN A. LAMBIE, County Engineer
WILLIAM, A. JENSEN, Supt of Building
LOCAL.TY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
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DESCRIPTION LOT NO
MAIL
"-5 ��" "
BLOCK TRACT ADDRESS
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ADDRESS j CONNECTION DATA
CITY STA iF'bN DEPTH
T E L. 2-
-�4 _
MANHOLE RRFERENCE
REGISTRATION NO. COUNT
7N- OF WORK FEE
TYPE 9P CQ� LENGTH FRAM
-HOUSE U- Si W-E R-C-Q-N- I @--3!5.00 `77-77
Uf3LfC SEWER L. M.L., TO P.L,
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PITS AND,DR DRATNFiELD @ sl6.00 JOB NO�
TRUNK PERMIT NO. ROAD FERMITNO. ' s
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT OFF—--- FF-�(DAV-IT -W"i E RECOR—DTWG-TR.NO. i DATE
WORK.TO HOUSE SEWER $3 00
OVE'R'L0W- -5EEP-A-6-E-P-17 ZMAINFI-CLO-
rXTN..CESSPOGL,DRYWE..L,,MA14.,OLE @- $5.00
HWY N
OR ST.WIDEING
OR�BANDCN HOUSE- i-
ce
SEWER OR DISPOSAL SYSTEM@ $3,00 STATE E ENCROACHMENT
PERMIT NO.
INDUSTRIA L
WASTE APPROVAL
OWNERS—] PERMIT 2. 00
CONNFCTiON CHARGE FEE
AUTHORIZATION TOTAL FEE
IHARCWH HREIN
VE AT THIS DATE A CONTAT ;TTHE E NAMED CON RE I'M DIS-M ENT_FEE
TRACTOR
R ACTOR TO CONNFCT THE ABOVE DESCRIBED EX!STING DWELLING
To THE ''U'qL[C 5 EWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OFL-----I9
OWNER OR
OWNERS AGENT'._ NE__ SEWER
CONNECT ADDITIONAL
BUILDING OR WROK
SEPTIC TANK,SEEP.PIT(SI
REBY ACKNOWL-EOr.r THAT I HAVE READ TWSAPPLICATiON AND/OR DRAINFIELD
-
A4M 0 'F 6 TATE THAT THE 5OVE !S CORRECT AND AGREETO COMP
LY
WITH AL.L COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU MB iNG AND SEWERS, CESSPOOL F DRYWELL
HEREBY
CER-4,FY THAT 1 AM. PROPERLY REGISTERED AND/OR AL�"FR,FMP,$IR,SEWER OR
HF
LICENSFD AS
'p<'Z�(NRtO BY LOS &NGLrS COUNTY NND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA, 0-F AND INTEND TOpISrCNNERLUG AND
tR-To4A�T 1 AM THE LEGAL-DOWNER.
RESIDE IN,tl�*.f A.ROVE' DESCRIBE Q O-ERTY. A BA N 0 ON HD USE SEWER
SIGNATOR
BACKFILL SEPTICTANK L7-
OF PERM�I.TiE SEEP, PJT(5) [j CESSPOOLS
VALIDATION ROBERT A. WOOD
CK. W O. c ASH, SUPERVISiNG MECHANICAL ENGINEER
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4 7 7 31.
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6A6421D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION S UL 111 N
JOHN A. LAMB1E, County Engineer A ..E..
WILLIAM A. IENSEN. Supt of Building
LOCA L TY
NE:AREcr
.
FOR APPLICANT TO FILL IN
CROSS ST _-z
.F.C111PTION LOT NO. ✓ OWNER
MAIL
ADDRESS
TRACT
aLoci,
NO. OF BLDG.
SIZE 0" LOTOT NOW 0-4 LOT X TY TEL. NO,
USE OF
I :LDING S s DISTRICT NO- Y7-
1 G _,UPI MAP PROCESSED By
3u, D
BK PG
ADDRESS -z zTa CONNECTION DATA
DEPTH
CITY TEL. N;!"'
UPPER
S'TA'TE MANHOLE REFERENCE
REGISTRATION NO. COUNTY
NO. I GESCRIPTt O. 0 ' WORK FEE TYPE Or C LENGTHFR6M
M.L 'TO P�,K
HOU SEWER CONNECTING 70 �2/C,
HUB IC SEWER @ $5
— ------00
T�P T HE TA'NK�, CEPAG`PYT R COIMP. NO. J05 NO.
AND'OR ORA!NFIELD
Ho $ESrWERC0NNECT;NC'TO TRUNK PFRMTT NO. ROAD PERMIT N
FRWATE DISPOSAL SYSTEM @ $3�00
CONAlEC'
E
T A0611FONAL SLOG.OR AFF �mP�
AFFIDAVIT F Wv. ASCMEMT
I WORK TO HOUSE SEWER @ $3.00 �7RECORD.INSTR. N67 DATE
OVERFLOW SEEPAGE Pi-T,_D
RAINPTELD J
EXTN CF5SIPCLDRYWEI.L.MANHOLE @ $5.00 D
_66- - -- HWY.OR ST.W1
ALT R—REPAIR ORABANOON A SE ENING
SE�;, SAL 6�YjgTFM sa.00
S�AT]CENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEH7'Sj
CONNECTION CHARGE FEE
AUTHORIZATION
I
HAYS AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- REIMBURSEMENT FEE.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO TH c'.
PUBLIC SEWER APPROVALS DATE LINSPECTOP7S SIGNATURE:
SIGNED THIS__DAY"OF
OWNER OR NEW HOUSE SEWER
OWNERS ACCENT_ ---------
CONNECT ADDITIONAL
BUILDING OR WORK
SEPTIC TANK.SEEP,PIT($)
ACKtINOWLEDGE: I HAVE READ T1,11S APPLICA-r$ON AND,'QR DHAINFIELD
AND,,
STATE, THAT THZ ABOVE 15 CORRECT AND AGREE TO COMPLY
WtTH ALL. COUNTV ORDINANCES AND STATE AWS REGULATING
W E RS.
LAWSPLuMB ING AND SE CESSPOOL. El DIRYWIELL 0
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED AS RE-.�U!REV BY L CS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM,
CA L7FORNIA OR THAT ) AM THE LEGAL OWNER OF, AND INTEND TO iSCONNECT PLUG AN
RESID, tN THE �4�BOVF DESCRIBED RFS�D,E>TTAL PROPERTY. ABANDON HOUSE SE WED
StGNATU RE SACKFILL SEPT!C TANKS El
<S). n C SSOOLS E: P
/'VALIDATION ROBERT A. WOOD
CK. W 0. CASH SUPERVISING MECHANIC-AL ENGINEER
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