HomeMy Public PortalAbout10566 OLIVE ST_Sewer__ D) ARTft'ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGNEAREST
ADDRESS j ,, + � 1 CROSS ST.
LOCALITY- -K' DISTRICT NO. SERIAL NO. PERMIT NO,
NEAREST :-> A S
CROSS ST. :.,.)Cam
_ ;�� RECEIVED BY Ready for Inspection DATE ISSUED
OWNER 7 `
MAIL
ADDRESS _ — USE ZONE ( OCCUPANCY MAP
BK PG
CITY '� TEL.NO.
CONTRACTORy— —ITT CO.IMP.NO.
ADDRESS _
_r!jaVERLY AVC JOB NO.
CITY lEMPLET9kTMQ.CALiF, -- —
TRUNK PERMIT NO.
REGISTRATION NO. ¢ COUNTY —
ROAD PERMIT N0.
LEGAL r STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT N0.
BLOCK TRACT
r y INDUSTRIAL
NO.OF BLD GS. WASTE APPROVAL
SIZE OF LOT NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO I REIMBURSEMENT FEE
PUBLIC SEW_ER 0 $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL'BLDG.OR I EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM I.00
DISCONNECTA D ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR .
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE I ':�: .
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_..,; .....DAY ORT 19J.-%f NEW HOUSE SEWER
OWNER R
� � CONNECT ADDITIONAL
OWNERS AGENT g,}} — / t �� •• BUILDING OR WORK
ADDRESS-/- S ..... ____.i _'S yi X+s._-..___._ SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- 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 1 AM PROPERLY REGISTERED DISCONNECT PWG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
J' SEEP.PIT(S)❑ CESSPOOLS
❑
SIGNATURE i
OF PERMITTEE....
7GA642D 663 1/53 1