HomeMy Public PortalAbout10625 OLIVE ST_Sewer__ Y
S0810APPLICATION FOR PERMIT
76A642D
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
33E , R. SCENT OF COUNTY ENGINEER
BUILDING AND SAF'E'TY DIVISION BUILDING
JOHN A. LAMBIE, County Eng inoer oDDREss {���`
WILLIAM A. TENSE%, Supt of Euilding � � —
OCALITY -
NEAREST
FOR APPLICANT TO FILL IN CROSS T
_. _.. 01 NO, OWNER
MAIL
BLOCK TRACT .� ADD,RE SS
Na. OK oLUCS.
SIZE OF LC"C NOW ON LOT .w_ CITY „� d° y 'TEL. NO,
U5E O
DISTRICT NO. GROUP MAP PROCESSED BY
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CONTRACTOR - _
ADDRESS,,.� .. - ..';;,9 CONNEO�'IOT
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CITY.c'• �'r4 ?'✓ TFL NO,.tea` y� s'Y ...- /STATJON— DEPTpl... _
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RE I RATION NO .� — y';daps-+ +'' r MANHOLE REi~ERE�`+CE �, SLOW
I� OU_N.TY. � � - �.
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NO. � PE S^RIP1 IC}Pd OF WORKFEE$5:GG TYPE OF CONN,F?.CYjION LEII H FROM
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HOUS
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PUBLI SEWER COW NECTING TO .��_-__i Y f8'U FF 1 _ P L M.?. TO N.L. L ey
PUBLIC-SEW FR � -'_"
_.. --T P.0 NO
I TIC.A ih EFFACE PiT OR
CO P Mi
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PITS 1PliD'Ja R
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RAtNFlLLL $9D.0!] ' `'r JOB Fdb 0
ribU C Eve G R CON td E..YiNG TO -- �'- - - - _-- -
PRIVATE DISPOSAL SYSTEM ,�:,-00 TRUNK PERMIT NO. ROAD PERMIT NES- Ul
--_-_ -- _--- -__ -_-.—, —_
CONI`IECT ADDITIONAL BLDG OR. AFF?DA'V7l, 5g1VAFR EAS�taENT RECORD INSTR NO I ATE
O �-'
WORK TO HOUSE SEWER _@ 6.3 0O
—_
WAWER'
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OVERFLOW SEEPAGE PIT,DRAINFIELD
EXT N,eESSF 06L,bRY WELL,MANHOLE�`�5',00
i
HWY.OR SY'.WIDENING
As TLR.r,Ft AIV-OR ABANDON HOUSE,_y,
EWER ORD D5AL Y57F,141
-.. �_ _.- STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL T..
WASTE APPROVAL ".
r
CHARGES
OWNER'SItER1�IY� ---- -- - - - - ---- - -
–
CONNECTION CHARGE FEE
A=ORIZATION FL
FEE
HAV' AT 'THIS DATE A CONTRACT WITH THE. HEREIN NAMED CON.. REIMBURSEMENT FEE
TRA:+ !
NEC,
THE ABOVE: bt5CR13ECcX15T'ING DWELLING ----._AP—._R_O_—V_A-- —_.__
POLCO
TO TM_ US .l€R
DATE iYlSPEGTOR 5 S.GNATU RE
S!GIYED.'T'E-3i5-----DAY U�-----------------�-5f>j—`-- — �--
OWNER OR NEW HOUSE SEWER
OWNERS _.--_--
--- CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS[--- ---- _.—_ _ __ _ _ -- --- --- ... ------__.:
_ __--- - - -- -
SEITO TANK,SEEE.F'I'T(S)
I HERESY Af'Kh O.YLEDGE THAT ! HAVE READ THIS APPLICATION AND/OR DRAINFIELb
AND -TATE 'I-HAT THE ABOVE IS -ORRECT AND AGREE TO COMPLY
W IT;IAL., CGU tTY ORD NANCVS AND STATE LAWS REGULATIN-G +
PLUM - AND EWERS CESSPOOL [] DHYWELL FJ
-
' I
N RLbY CERYIFY 'r .'A . AM PROPERLY REGISTERED ANA/OR ALTER,RC£IAIR,SFWCR OR
LICENSED AS Rk,QU IRF_F. BY LOS ANGLES COUNTY AND STATE OF SEWAGE 015PO5AL SYSTEM
RESIDE
CALirORNDA OR 'THAT I AM HE LEGAL OWNER OF AND INTEND -10ICD
O "- -----"'
IN, THE AEcI'E - DISCONiVk CT PLtG A
D CRlBE�
N"RFfiAENTiAL PROPERTY ' ABANDON HOUSE SEWER
,d' �� - Jy�" L"r BA.L.}(FILL EPTICTANKS ! �.
OF PERM ITTF'E ,-_"� •J�.F _ _ _c,e_._t '.' SEEP.
PIT(s) CESSPOOLS
VALIDATION ROBERT A. WOOD
N
NCV'_ M,0, AS' StUPERVISING MECHANIC-Al. E�tGINE:ER
p
tl /l
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Cc80g PC1»f�76-A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 9
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS —
WILLIAM A. JENSEN, Sud t of Building y
c ooAL Tv :C l ` — -
NEAREST
FOR APPLICANT TO FILL IN cRdss 5r
LEGAL -
nasCR1 TIdN LOT No
OWNER
MAIL,
SL.00 K RA.CT ADDRESS �''` +`� ^'� p ✓g' ,�
.--_._ ._... - ___- _.-__._._ y '.k-:-. r-_�-�- ✓ y�...dam`-....°.._ ',e.P-..-_.. ��
.v t_ —
LC O ' LOT ---. Plow ON LO'C' �.> Ci7_ +" TEL. NO,
i SE. F
DISTRICT NO GROIf i> MAP -PROCESSED By
B !LD kUz u L y
SK PG
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CONNECTION DATA
T'-a TEL N0.• -'s`
STATE - U-p
MANHO.E RE:F£s'(6:NCF_
REGI IRATION NO. r' it;% ❑ {'OUNTV 1 __ LOWER
t C. GE.54R1}YlON OF WORK FEE _ rYC t.F r""Ni=LE'.CT1GPti LENuT'[?FROM �p�,
EHOUSE SW F',:ONNE:CfING TO - y- Y. .CU�Rd - 1_-- M.L T7 P.L "' 0
)di C'.9ENE<
SEFTIC ANK SEEPAGE 'IT OR
JO E3 NO
t.i
Il A^D nR DRA N ILLD (a) slo.o0 -. CO.IMP NO. :J
"T U,:L FEWER(:uNt C7'tJ i;TO
PRIVATE DIJPOSAL SYSTEM -' $3.GD rPllNK PERMil NO. ROAR PE R'+a T
:.LDG OR { AFFIOANIT wmvi' I EASEMENT `I REGORG.. h'STP NOx 1 DAZE
CON dF O ADD T'ONW "' - "--------'-�--- -—I-^---J
WORK T+7 rlu E SEWER � �s.co , �
LU
OVERFLOW EEI':tOEPIx,DRA.lN GI EL.D
E T4,CE POOL,DRYWELL,MAN HOLE S5.00
a1 Eftli
__-.— _.REPAIR OR aG+A ND4'J --- d3 .D HWY.OR ST.WIDENING
' . .N s;O -:+E I - I
S 'A"iR OR GI +'OSA SYSTEM v. .STATE ENCROACHMENT
PERMIT. NO.
IND'J S-f RiAL f
j WASTE APPROVAL
CMNE117'S hEmT` -21
CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL I-EE � �j ---- ---" ------- ------- ----- ---.�
If E!ML'URSFMENT FEE
I HAVE AT T'H{. DATE A CONTRA�..:T WITH THE N'cREiG+i yRfAMED CON --- -----
xRACTOP TO CONNECT THE P,SOVr DESCR[BED EX'G7b G DWELLING --- ---- --'
_- �yg'g7--pyt� _--
TO THE PU8L i(' SEWER. APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS......_DAY 0
Ov"N}F OR ,�X,s ,Y _ NEW MOUSE SEWER
G FV NERu AGENT—
CONNECT ADDITIONAL _. -
-- BUILDING OR WORK, �
SEPI
h{1
..BY A :PIOWLEDGE l'HAT i HAVE READ THIS APPLICATION O TANK,SEEP,PIT(,S)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO AND/OR OR DRAIN;!E_D
:i. COMELY
WITHA L. COUN"Y' ORDINANCES AND STATE LAWS REGULATING
PLUM,._ING ANC SEW_RS.. CESSPOOL. !_ ORYWEL? Ej
I HERE"BY CERTIFY THAT i AM PROPERLYREGISTERED AND/OR ALTER,REPAIR,SEVVER OR I
LICENSED AS REQUU ED BY i3OS ANGLES COUNTY AND STATE OF SEWAUF DISPOSAL SAL SlST EM '
CA!_IFORNIA OR THAT ],,Q. THE LEGAL OWNER OF, AND INTEND TO _ .__
D SCo NL T PLUG AND -
*ES?D.. IN, THE ABOVt PSCR-IBFD R DE.N Y L PROPERTY I
yy,s�' ABANDON HOUSE SEWER
SIGNATLI RE p'
OF PERM ITTEE � ..+';_r_. .+i'� ',,. '` <'J 3R ?(FILL SEPF,C TANKS.[�
_ `-+--d-'by"L'.=c�" .G •=____.__ SEEP.PIT(s) ❑ CESSPOOLS
,VALIDATION ROBERT" A. WOOD
SUPERVISING MECHAWCAL E3 GINLER
C.K. M.O. CASH