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HomeMy Public PortalAbout10629 OLIVE ST_Sewer__ A64203-6' APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDINGEG � v JOHN A, LAMBIE,County Engineer WILLIAM A. JENSEN. Supt of Building LOCALITY NEAREST FOR APPLICANT TO MI-IN CROSS ST. LEGAL ` ~ OWNER ` DESCRIPTION LOT NO. BLOCK TRACT MAIL '� ADDRESS .NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL.NO. USE OF BUILDINGS f 1-r,_ D'4ANHOLE STRICT NO. GROUP MAP PROCESSED BY �f J� K PG CONTRACTOR ADDRESS,- _ - �- - CO CTION DATA CITYILY� — r 1 r _ z TEL.NOt�'�� � j ST T4 ✓ ! DEPTH STATE REFERENCE f REGISTRATION NO. p ,_ �"1 lJ COUNTY f�' LTjyVgg`+ NO. 1 DESCRIPTION OF WORK FEE ----- AHOUSE SEWER CONNECTING TO SEPTIC TANK,PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAEINFGE �[T OR $5.00 Y. CURBP.L, MA.TO P,L. OVERFLY SEEPAGE PST.DRAINFtELD r EXTN..CESSPOOL.DRYWELL C� $2.00 HOUSE SEWER CONNECTING TO f e P.C.NO. O PRIVATE DISPOSAL SYSTEM C� $1.00 CO.IMP. N0. JOB N0. LJ ✓moi J-..,,y y !, Ix CONNECT ADDITIONAL BLDG.OR IT.RRMIT NO. ROAD PERMIT NO. ` WORK TO HOUSE SEWER SLOO ALTER,REPAIR OR ABANDON HOUSE CROACHMENTWERVDISP05ALSYSTEM $1.00O. UALPROVAL CHARGESTT OWNER'S PERMIT 3 2ON CHARGE FEE AUTHORIZATION TOTAL F'EE SEMENT FEE I HAVE DATE A CONTRACT WITH THE CON- TRACTOR ATTOCIONNECT THE AB VE DESCR[ED EXIISTI�NGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER, SIGNED TRIS DAY OF 79� NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUI LOING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL CI DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT tI AM HE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS [] DESCRIBED RESIDE L RO .- r " SIGNATURE SEEP.PIT I ., CESSPOOLS OF PERMITTt'.' ro rl --VALIDATION ROU RT A. WOOD Cx. R.O. CAST! SUPERVISING MISCHANICAL ENGINEER J /i R a :E808 3-61 6 A 642'J APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / _ , JOHN A, LAMBIE, County Ea near ADDRESS ° WILLIAM A. JENSEN. Sup't of Building LOCALITY NEAREST LEGAL F R APRICAM TO FML IN CROSS ST. DESCRIPTION LOT NO.IV" ,t c" � OWNER �i �' d TRACT MAIL ,{? i t' ADDRESS NO.OF BLDGS. NOW ON LOT CITY TEL. NO. ..f DISTRICT NO. GROUP_ , MAP P OCESSED BY BK Poi i z C 1. .._,,' CONNECTION DATA CITY EL.N0. ' ION y l DEPTH + ' "NATE MANHOLE REFERENCE REGISTRATION PI - COUNTY r>' C' %. LOWER N. I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $8.00 TYPE OF CONNECTION LENGTH FROM f SEPTIC TANK,SEEPAGE PIT OR Y. CUR P,L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $8.06 OVERFLOW SEEPAGE PIT,DRAINFIELD ' _— EXTN..CESSPOOL.DRYWELL @ S2.00 1_'_t14'­" CL HOUSE SEWER CONNECTINGPRIVATE DISPOSAL SYSTEM TO @ $1.00 yCo.IMP,NO. I C. r / JOB N0. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK T'0 HOUSE SEWER @ $1.00 0 SEWER,R PISFOS L AN NN HOUSE @ $1.00 STATE ENCROACHMENT PERMIT NO. U LU ;y �` - _•-^ INDUSTRIAL - 1L L.k WASTE APPROVAL h CHARGES Z ®1I►I Frs PERMIT I - CONNECTION CHARGE FEE AUTHORIZATION TOTAL. FEE REIMBURSEMENT FEE DATE A CONTRACT WITH THE HEREIN NMED CON- TRACTOR TO CIONNECT THEA©VE DESCRIBED EXISTINGADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF J9 —_— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL CJ DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE14 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR TH ,T I AM HE LEGAL OWNER OF THE ABOVE BACKFILL SEPT)C TANKS DESCRIBED RESIDE L fRO TY ' �✓ " SEEP PIT( ® CESSPOOLS SIGNATURE �'- OF PER.MITT€ - d?_ .•' :1 '.- `VAUDATION ROBERT A. WOOD C6. N.6. CAStI SUPERVISING MECKANir-AV ENGINEER r/