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Home My Public Portal About10643 OLIVE ST_Sewer__ CE800 3-62 7e-A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUILDING ,A JOHN A. LAMBIE, County Engineer AD-DRESS WILLIAM A. JENSEN, Supt of Building LOC-AL_ "y I"I Y C:"k- Xli�L' N EARFSr FOR APPLICANT TO FILL IN CRO--S$ SV LEGAL DESCRrPTION-- LOI NO- OW,ER MAIL -BLOCK TRACT ADDR r5, NO. OF' BLOCS. size OF 1:0T ', r7 NO ON LOT TEL, NO. USE cr BUILD,NGS DIST NCT NO. Gp(l;P MAP PROCESSED BY Sit PG CONTRACTOR ADORE SS Ql CONNECTION DATA STATION DEPY CITY TLC.- NO. PEGISTRATiON STATEMANP-t OL F_REFERENCE UFP9R COUNTY NO. 1 DESCRIPTION OF WORK ____FEE TYPE,OF CONNECTION LENGTH.FRCS`+9 HOUSE SEWER CONNECTING TO Y. CURB P.L. Poi.TO P.Ll' PUBLIC SrWEF roe - —--- ------- ----.--- — -�--�o—�---—'- L___.__. P.-,-.NO. SEPTIC TANK,SEEPAGE PIT OR J 1 PITS AND/OR DRAINFIELO @ $1000 _CO JOB NO. PCjs L',EWER CONNECTING TO TRUNK PERMI1 NO. ROAD PERMIT No. i PRIVATE.DISPOSAL SYSTEM @ $3.00 WC2 CONECT AUDIT ANAL BLDG.OR SE SEWER 53�00 AFFIDAVIT -4 N6AVIT WMVER I �ASE.E.T RECORD.1STR NO. DATE WORK TO HOU OVERFLOW SEEPAGE PIT.GRA IN51ELD- Ex�-N.,CESSPOOL.ORYWELL.MANH.OLE $5-00 Hwy OR ST.WIDENTNG ALTER.REPAIR SEWER OTSPOSAL SYSTEM $3.00 STATE�NCROUACHMENT -7 PERM! - I N.O. INOU'3rRIAL WA5TE APPROVAL -PE -- ----- CHARGES OWNEWS RMIT 2� 00 �:ONNECTION CHARGE FEE AUTHORIZATION TOTAL FU HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA I MED CON- REIMBURSEMENT FEE TRACTOR TO NCONF- B -T THE ABOVE DESCRIED EXISTING QWELL.TLL2GG -3 THE .jB SEIAI-�F, APPROVALS DATE, j INSPECTOR 3 SIGNATURE SIGNED THS S JDAY OWNER OR NEW HOUSE SEWER OWNERS CONNECT ADDITIONAL BUILDING OR WORK ADDRESS 5EPTIC TANK,.SE-iiPA", 4' HERFRY ACKNOWLEDGE THAT I HAVE "CAD THIS APPILICA � TioN AND OR DRAINFICLO 7r) STATC THAT THE ," ABOVE IS �OrPEI;y AND AUREE TO COMPLY WITHA!.)., COUNT Y CIRDINANrE5 AND STATE LAWS REGULATING FLU M B ING AND SEWERS. CESSPOOL DRYWFLL I HEREBY CERTIFY THAI IN AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR Lj CO ]RED Z' ENSED AS REU I_G' ANGLES COUNTY ATGSYT AND SATE OF SEWAGE DISPOSAL 5EM 'y C. ALIFORN A OR THAT I AM 'r IE LEGAL OW FIR OF, AND INTEND TO RESIDE IN, THE ABOVE DES�-:R JBEDRESIDE. PROPERTY 15 NNECT PLUG AND ,jq A5ANDON HOUSE SEWER SIGNATURE OF PERMITTEE_ BACKFIL; SEPTIC TANKS LE) CESSPOOLS x I VALIDATION ROBERT A. WOOD SUPERVISING PAIECHANiCAL. ENGINEER ylj CK W Q. CASH Lit' A . - 76A;64LD-CE208 A-7/76 & APPLICATION FOR PERMIT SEWER—SEWAGE DISPOSAL COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN DISTRICT NO.1 GROUP I BK MAP PS PR07ED BY 0 BUILDING ADDRESS CONNECTION DAT),_,/ 'Tf T LOCALITY �y'j_ A ON NEAREST STATION DEPTH CROSS ST. -3 71-03,y �JIMANHOLE REFERENCE ?tfW R OWNER TYPE OF CONNECTION LENGTH FROM MAIL Y. CURB P.L. M.L.TO P.L. ADDRESS P.C.NO. C CITY 'TEL, NO. I.P.NO. JOB NO. . LEGAL TRUNK PERMIT NO. ROAD PERMIT NO. _DESCRIPTION LCT NO. "j-;l 1(t 79P 0 _ WAIVER EASEMENT RECORD.INSTR.NO. DATE BLOCK TRACT 7(C NO. OF BLDGS = SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING USE OF STATE ENCROACHMENT BUILDINGS PERMIT NO. CONTRACTOR f s INDUSTRIAL WASTE APPROVAL CL ADDRESS CHARGES 0 CONNECTION CHARGE FEE CITY NJ TEL NO. STATELIC REIMBURSEMENT FEE 0 , LICEN L NO. V CLASS U NO. - DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE HOUSE SEWER CONNECTING TO 0. PUBLIC SEWER W SEPTIC TANK.SEEPAGE PIT OR NEW HOUSE SEWER z PITS AND/OR DRAINFIELD CONNECT ADDITIONAL ,T—OUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM SEPTIC TANK,SEEP,PIT(5) CONNECT ADDITIONAL BLDG.OR i AND/OR DRAINFIELD I WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL 11 DPYWELL EXTN.,CESSPOOL.DRYWELL.MANHOLE @ ALTER,REPAIR OR ABANDON HOUSE ALTER.REPAIR,SEWER OR SEWER OR DISPOSAL SYSTEM @ SEWAGE DISPOSAL SYSTEM II DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS-d— ❑ OVVNER'S Llssuance Fee SFEP.PITts) El CESSPOOLS IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AUTHORIZATION TOTAL FEE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- PLUMB!NG AND SEWERS.RS, T RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING S APPLICATION C AT'ON COMPLY I E Pp] E T 0 REGULATING ULAT. TO THE PUBLIC 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE,OF SIGNED THIS DAY OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND __ OWNER OR RESIDE IN, 'THE ABOVE DESCRIBED RESIDENTIAL, PROPERTY. END TQ OWNERS AGENT, '.-%or SIGNATURE ADDRESS OF PERMITTEE' I lit VALIDATION"� Cc _< C /a tL. C -1,&- It_4e C CK. M,O. CASH t v