HomeMy Public PortalAbout10557 OLIVE ST_Sewer__ E808 fO-63
6A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
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BUILDING AND SAFETY DIVISION t9�J I L D 1 Nr
ALDOR E,
JOHN A. LAMBIE, County Engineer
--
WILLIAM A. JENSEN. Supt of Building
LOCALITY
CkOSS ST
FOR APPLICANT TO FII L IN
1.GT N 04"
OWNER
J
MAIL
BLOCK TRACT AODRESS
NO (f]` BLOCS,
SIZE OF LOT NOW ON LUT' CITY TEL N
USE OF
ciSTRBUILD NCS !CTNO-
PC
13K
CONTRACTOR ''t z
ADDRESSCONNECTION DATA
-Ace'
TEL. ST DEPTH
STATE MANHOLE El,�!�v FIER
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REGi TRATION COUNTY
rFSCRIPTION OF-WORK FEE LENGTH FR016-
,
HOUSE SEWER CONNECTING TO • MAL. TO P.L./ y.
pu 9L'C SEwrR P.G.NO,
PT'IC TA'NK.SEEPAGE PIT OR CO I M P NO, jOB NO. 0
PITS AND,,OR ORAiNFIELD @ $1000 j- -----
HOUSE swEIicawmET'i"c; --
TRUNK'PERMIT NO. ROAD PERMIT NO.
� T
PRIVATE�IPOSAL SYSTEM. @ S3 00
NO. DATE 0
WORK TO HOUSE:SEWER S"Q
OVERFLOW SE:EPAGE PIT,DRAINFIELD
E�XN WELL,MANHOLE $5,00 WIDE
ALTER,REPAAR--6F?A—BANTOCON-4i5-U-Sr- HWY.OR Si. NING
L
OR DISPOSAI 5-YS-T-Em -3.0c) STATE KNGRQACHMFNT Z_
PERMIT_ '40,
iNDUSTRIAL
WASTZ APPROVAL
CHARGES
OViNER;-s-----�---P-E--R--M-IT--- 21 00
V
TAI�iE CONNECTION CHARGE FEE
L
AUTHORIZATION
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA.MED CON REIMBURSEMENT'SEMEN1 FEE
TRACT,1RTO,cO,','.1E<7.T THE ABOVE DESCRIBED EXISTING DWELLING
P
TO THE USLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS-—DAY 901!`'---
OWNER OR NEW HOUSE SEWER _
OWNERS CONNECT ADDITIONAL
BUILDING OR.
on R P T-�-C TANK,- -SEEP,P I T(5)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA71ON AND/OH L�RANFIELD
0 E COMPLY
AN STATE THAT THE ABOVE !3 CORRECT AND AGREE. TO
V✓ITH ALL COUNTY ORDINANCES AND-STATR LAWS REGULATING
E'L-I,J M B ING AND SEW E RS. CESSPOOL 0 DRYWELL [-j
I HEREBY THAT I AM .PROPERLY REGISTERED AND OR ALTER,REPAIR.SEWER OR
SY LOS ANGLES COUNTY AND STATE: OF SEWAGE DISPOSAL SYSTEM
OWNER
W N ER
CALIFRNi R IVAT I AIM N4F 'GAL 0 F, AND INTEND TO DISCONNECT PLUG AND
R HOU
ES DE IN IF A'paVF DzscRIBFILk RESIDENTIAL PROPERTY. ABANDON SF.SEWER
S?G N A"t IJ
OF P BACKFILL.SEPTIC"TANKS L
SFEP,PIT(5) -CESSPOOLS
E]
L II I
VALIDATION ROBERT A. WOOD
e SLIPIERVISiNG MECHANICAL ENGINEER
C.K. M.O. "CASH
0 4 7 1?-,-k� f
- r
:E808 10-63
6AE� APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER $;I
BUILDING AND SAFETY DIVISION BUIL DiNc r' s
JOHN A. LAMBIE, County Engineer ArDRESSZ� --- t ----f — -
W ILLXAM A. JENSEN, Sunt of Building
LOCALITY
FOR APPLICANT TO FILA, IN CRCSS T ' °, `a" x
IIESCR PT(ON L'-'r Nf I,,T - OWNER 'i.
Bi_OCK -]-FACT � ✓ i' �':. MAI:.ADDRESS
��—. _ 'a✓
v}
SIZE OF LOT NOW ON LOT' '� CITY TEL. NO_'., u 11 .
USE OF
BU ILDINGS -' DISTRICT NO. GROUP MAP In Oc E5Eg BY ;
BKPG J
} r E C
"
CONNECTION DATA
y l
ADDRESS
1::'__y, '�.y�-�'` !'_T:''�' "�—__��' __�'�a� �_ -a.�-.�,..v-T'--•__��. --__. _ — _— �-__ —_
CITYTATE
J� COUNTY MANHOLE kE4�EFiENC �
r
UPPER
REGISTRATIONNO ,
NO-7 C£SCR[PTION OF WORK FEE -'a'YRE OF gL<)NN>:tTION -_.. -' - ,- --
LEPiv I'H FRLiM
HOUSE SEWER CONNECTING TO T "-- -_-- Y i _ 'C.klFCB P L M.L TOPE. `} a
PUBLIC SEWER L 55.00
.._ .. '. P.C.NO. 0
--�5EP71C TANK SEEPAGE
n + CO.IMP. NO- JOB NO
Y4T,A',;D_r OR DRAIN IELDu SIB.00 ,�._�__._ �___�� __-- _..______..-__
I NOUS SEWER ,ONNECTiNG TO TRUNK PERMIT NO ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM S3.00 -
J
CONNECT AOO.I CONAL BLDG OR � i AFFIDAVIT �WMVER j eassntenr T- i7E CORD iNSTR NO.. DATE
aVORK TQHOU SESEW ER @ $3:00 �� I -
V__ f`V Vd .Cj
ERFLOSEEPAGE PIT.DRAINFIELD —T---- i ...� L _1__— �
J .
EJCTN GESSPQO L,DR WELL.MANhi'OLE Q $5,00
__ _.— HWY.OR ST.WIDENING
ALTER, REf A R G:R AE3ANDON f•IOUb""€
EWE C P.�.SA Y TEM $3.00
L —) - -- —« STATE ENCROACHMENT
PERMIT NO.
INDUSTRIA .
WASTE APPROVAL -
____T.
OWNERS PERMIT -- --- - --- ----
AUTHORIZATION TOTAL FEE ` CONNECTION CHARGE FEE:
-I HAVE A'i' THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -"_.__.. _—/q—gyp .....____-.1_—...._.___�._'__-.`
TO THE PJBLSC SEWER. Amm YALw7
DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY Or'
OWNER ORj' NEW HOUSE SEWE7R
OWNERS AG, NT_—_T� �- ,_._.._ �__—_ CONNECT ADDIT10NAL
BUILDING OR WORK _-_I.---
ADDRESS_
_. r - �— ".-J_ SEPTIC AND,ORANK.SEEP. IT(S)
I HFRLOY ACKNOWLEDGE THAT I HAVE RF"Ai.T THIS APPLIY 0.TION I
AND
SATE THA. THE AhDVE IS CORRECT AND AGREE TO COMPLY -----{— -.--- -----_
WITH ALL CCl;NTY ORDINANCES AND STATE LAWS REGULATING
LU!�e'NG AND SEWE RS. CESSPOOL Ij DRYWELL ❑ '' y�—__ _ ______
i HERESY CERT FY THAT I AM PROPERLY REGISTERED AND;/OR ALTER REPAIR, EWER )R
LSC'ENSED AS Rr OL:IRFO BY LOS ANGLES COUNTY AND SATE OF SEWAGE DISPOSA —_I
C'ALI ORNIA OR `_e+AT I AM I _EGAL OWN R OF AND INTEND TO —'---?' i -'-- - ---"-
R S:DF' N. TH`�ABOVE DESE'R!BED DISCOT NLCT PLUG AND
> _ E�ID Nb�tAL.'PRQPEfP.T Y. ABANDON HOUSE SEWER
SIGNATURE BAC'KrI LSEPTI( TANKS
OF PEi2 frY17"i'E _ _~ -_) __ _ _ _ 8 __ --___ SEEP,PIT(S) L�. CESSPQ OLS
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O CASH
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