HomeMy Public PortalAbout10639 OLIVE ST_Sewer__ DEPAWMENT OF COUNTY ENG=ER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
,COUNTY Or, LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER + ABUILDING
DDRESS
FOR APPLIC. NT TO FILL IN LOCALITY ,x,.�,,;,C�
BUILDING NEAREST
ADRESS , ,CROBS ST. 1 L/=�
LOCALITYj //-,f��i P �• r_ ISTRICT NO. SERIAL NO. PE MIT NO.
CROSS ST. i�� ( A. S
REC VED BY Ready for Inspection. DATE ISSUED
OWNER , R.-.
A DAILRESS C�44 S /\p �i�USE ZONE OCCUPANCY SK MAP PG
CITY L.NO. - / I
fff 1 _ I
CONTRACTOR C/g
ADDRESS , �� j ,,4
^ JOB N0.
CITY)ldMl
TRUNK PERMIT NO.
STATE ;.
REGISTRATION N0. �/ �] COUNTY. ROAD PERMIT NO. _1
LEGAL
DESCRIPTION LOT N0. �� STATE ENCROACHMENTPERMIT N0:
BLOCK TRACT �Q WABTSE APPROVAL
SIZE OF LOT �� N MO. BLDG6.
NOW ON LOT ( CHARGES
USE OF
BUILDINGS CONNECTION VHARCE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO y� _
PUBLIC SEWER @ $ 8.50 `J ! RECEIPT NO. DA E,�' BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1:00
CONNECT ADDITIONAL BLDG.OR f EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO• I DATE Bl(�'*
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/OR DRAINFIELD 2.00- STATION I'l)�, DEPTH
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE
*7.6, � b`1 UPPER
! TYPE OF CONNE ION.+.e, LENGTH FROM
OWNERS PERMIT ; I oo ,x-- �}RB-'- L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE
E DDESCRIBED EXISTING APPROVALS INSPECTOR'S.SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
/�7'/1
19., NEW HOUSE SEWER C�� 1r ;✓���' ,
SIGNED THIS_ t._.._._DAY OF.__.. .,..__.,......_....._. .
OWNER OR .� v "f' n ' CONNECT ADDITIONAL
OWNERS AGENY.`.r`�*' y Y r:_w..i".'_.: _ BUILDING OR.WORK
` f.+�1 - . o ' SEPTIC TANK,SEEP.PIT(S)
ADDRESS J .�� 1�.: :.!. ;!. i ,".r'y p AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT)
HAVE READ THIS APPC1 CESSPOOL 0 DRYWELL 0
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 I AM. PROPERLY REGISTERD 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-
IG PERMITTEEER OF THE OVE DESCR D' ES DFEN PROPERTY� BACKFILL SEPTIC TANKS
SEEP.PIT(S)� CESSPOOLS-0 e t IS1. R
SIGNATURE .[y/,��/.,+�C S�Lrf
76AeUD JIM 1/50 4-