HomeMy Public PortalAbout10558 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
L-1VISION OF BUILDING AND SAFETY PERMIT APPLICATION
e COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING - NEAREST
ADDRESS a O CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ' j ✓L
MAIL
iT
ADDRESS C',S E USEZONE OCCUPANCY MAP
BK PO
CITY - TEL.NO. 4� d 1
CONTRACTO '' d
CO.IMP.NO.
ADDRESS Y JOB.N0.
CITY TEL.NO.,> TRUNK PERMIT NO.
STATE
REGISTRATAN NO. COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 2 STATE ENCROACHMENT
s+' PERMIT NO.
BLOCK % TRACT '' ( _ INDUSTRIAL
WASTE APPROVAL
SIZE OF'LLOT j NO.OF BLDGS.
r +�- NOW ON LOT -• CHARGES
USE OF
BUILDINGS� CONNECTION CHARGE FEE
NO, DESCRIPTION OF WdRK F E REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER a $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. DATE I BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 ( CONNECTION DATA
8EPTlC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTIONLENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ f I OD
AUTHORIZATION TOTAL FEE -
i HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_ .......DAY OF. _ . J NEW HOUSE SEWER
_ i '
,OWNER OR ,� ''� + /$ � CONNECT ADDITIONAL
OWNERS AGENT ' BUILDING OR WORK
A _ SEPTIC TANK,SEEP.PIT(S)
ADDRESS? f...._...____�°?�iG?_ � - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A LI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT F AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN•
ER OF THE ABOVE DESC�RIJ IDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE L 7�uEZ z ,ta�w�• SEEP.PIT(S) CESSPOOLS 0
OF PERMITTEE-.. } , - .__,_......
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