HomeMy Public PortalAbout10651 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING `
ANEAREST
DDRESS
CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST - /4 - - I S
CROSS ST.
RECEIVEn BY Ready for Inspection I DATE ISSUED
OWNER
MAIL
ADDRESS USE zome OCCUPANCY MAP
f SK PC
CITY TEL.NO.
CONTRACTOR
-- CO.IMP.NO.
ADDRESS
10B.NO. r _..,__._..-..._
CITY TEL.NO. TRUNK PERMIT N0.
STATE
REGISTRATION NO. -�--__ ,-
L COUNTY ROAD PERMIT NO. - -
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO,
BLOCK - TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE '
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE --
HOUSE SEWER CONNECTING TO
PUBLICSEWER 3.50 I RECEIPT NO. I DATE f 8Y I
HOUSE SEWER CONNECTING TO I 1'
_ PRIVATE DISPOSAL SYSTEM 1.00 I I
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO. ) �4rr I,Gy
ALTER OR REPAIR EXISTING =_-
SEWER OR DISPOSAL SYSTEM 1.00 `��� 1
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR y
PITS
-- AND/OR DRAINFIELO 2.00 STATION y
DEPTH
CESSPOOL—DRYWELL
.�
SPECIAL CONDITIONS ONLY 2.00 I s- ,r MANHOLE REFERENCE
.5 UPPER LOWER,
TYPE OF CONNECTIONLENGTH FROM
- Yr 1riiRR-
P.L. M.L.TO P.L.
OWNERS PERMIT $ •F1 00
AUTHORIZATION TOTAL FEE I -
1 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 OF. 19 ____ NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT ` �_; BUILDING OR WORK
y
ADDRESS ' ffy f SEPTIC TANK.SEEP.PIT(S)
_ •- ••.- " � AND/OR DRAINFIELD
1 HEREBI AKI6Vd'>JEDT �SAD THIS APPLI- CESSPOOL(-I DRYWELL
CATION AND STATE YNAT- HE �ORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
ANO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ABANDON HOUSE SEWER
ER OF THE ABOVE D+ESCH]BED-WSIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)D CESSPOOLS E]OF PERMITTEE..
/sem,.-.-•-----= -
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