HomeMy Public PortalAbout10561 OLIVE ST_Sewer__ DEPAIiTAYE1VT OF COUNTY-ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT' APPLICATION
CoumY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
�~ ADDRESS'
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FOR APPLICANT T FILL INLOCALITY
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BUILDING' NEAREST
ADDRESS ° CROSS ST. 1
LOCALITY / DISTRICT NO. SERIAL-NO. PERMIT NQ.
NEARESTA f I S
CROSS ST.
E EIVEDIBY Ready for lespoWes, ` DATE ISSUED .a
OWNER r , ! I,w.eQd y
ADDRESS / USE ZONEUPANCY BK MAP PG
CITY TEL.NO. V�
CONTRACTOR„u•1,1[fornia goyer' Const-CAI CO.IMP.NO.
ADDRESS 1317 Cole,'-',rove Ave. JOB NO:
CITY er, sntebe110 TEL.NO�TNion 1.-5048 TRUNK PERMIT.NO.
REGISTRATION 1110.12444.5St., QOU TY 4
LEGAL r(st t�=J ROAD PERMIT N.O. _
DESCRIPTION LLOT N0. _// - STATE.ENCROACHMENT
PERMIT NO.
BLOCK TRACT i4 9b WASTE INDUSTRIAL PROVAL �
SIZE OF LOT r7 qq A NOW(
BLDGS..
Col �Ld NOW ON LOT ` CHARGES
USE OF
BUILDINGS. CONNECTION'CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO /q
PUBLICSEWER 9.50 (d RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO-
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR �E ION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING KO. I DATE Y.
.SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS.AND/ORDRAINFIELD 2.00 STATION g.F d 'DEPTH t
CESSPOO L-DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 , ^ t MANHHOLLEE REFE
4N E [ ".NN;
TYPE OF CONNECTIO�1 LENCH 006M m.
PERMIT $ 1 00 � OCRB �P= M•L.'TO P.L.
OWNERS _
.AUTHORIZATION TOTAL FEE
I.HAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
CONTRACTOR.TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIONAT-RE DATE
DWELLING T0. THE PUBLIC SEWER
SIGNED THIS— ,DAY OF--._ _19— NEW HOUSE SEWER � , ? wry:
OWNER OR c CONNECT ADDITIONAL:
OWNERS AOE i --.j _ BUILDING OR WORK
ADDRESS F____ r`_ SEPTIC TANK,SEEP:PIT(8)
f� = - =- � F ----- AND/ORDRAINFIELD
I HEREBY ACKNOWLED E THAT 1 HAVE READ THIS APPLI- CESSPOOL DRY111IELL
CATION:AND STATE.THAT THE ABOVE I8.CORRECT AND AGREE,
TO COMPLY WITH ALL.COUNTY ORDINANCES AND STATE LAWS ALTER:REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS: SEWAGE DISPOfiAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLYN'REGISTERED DISCONNECTPLUO.AIID _
AND/OR LICENSED A8 REQUIRED BY. L08 ANGELES. COUNTY .ABANDON.HOUSE'SEWER
AND STATE OF CALIFORNIA OR HAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESC BED ESIDENTIAL PROPE BACKFILL SEPTIC TANKS
A SEEP.PIT(S)[] CESSPOOLS[�- �C
SIGNATURE,. K to 9 °
OF PERMITTE .-a.-. . _
TOA6420 663' 1/5$ /� _ ,-