HomeMy Public PortalAbout9073 OLIVE ST_Sewer__ cEdQ s-6 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DI'V'ISION fAIDDRESS
UILDING
pfSHPN A. LAMSIE, County Engineer WILLIAM A. JENSEN, Supt of BuildingOCALITYEARESTROSS ST
FOR APPLICANT TO FILL IN _
DES('R ii ON LOT NO y. OWNER '��'" _ _ �,_✓"1. _____..- _..__
MAIL. ". i
BLO"K TR:ACCY$ ADDRESS
. OF 5LDGS.
SIE-E OF LOT ON LOTS. �,}�. CITY TEL. NO.
USE /`F DISTRICT NO. GROL.P MAP PROCESSED BY
IS K BU.LCINV4 'r �.. ,
G e
CONTRA-TOR
/ P
ADORES ae` '_— `_".__ CONNECTION DATA
CITY ..""'t TE NO. i.r ' ' S'(A�..F0N � / � �P � DE -H
-- -- _- -- ,amu_ ._/0_ -
❑ S'fATEs. x. _°?PPCF'
REG!STRaTF� COUNTY ANFd(?LERFER2=NCE
ION ti -'. Md
t--v .r_LY ❑ z f Yr
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NO. ESCRIPTION Ot- 6RK F T5` F OF CO ,W EC N, -�� LEY.
NGTH F +JM
w P L �},y(`_ -M_L TO PTL,
d� n U S L C S W E R @ $5.00_ I � €; ��= 2 -.'t— --_�-
SEPTI TANK SEEPAGE PIT CR -_ -+ - f "t y P.C.NO
FITS AND/OR DRAINFIELD @ 510;00 CO.EMP. NO. a' JOB NO.
T
HOUSESEWER CONNECTING TO +—_-`T-
F RIVA TE DISPOSAL Y TEM G3 I TRUNK PERMIT fJ0 ROAD PER3AIT NO- I
53.OG Oa
CONNECT ADDIT,ONAL,BLDG OR � � AFFIDAVIT WAIVER P ¢as4-N.4?IT � RECORD INSIFt NO , DATE
WORK TO HORSE:.EWER @ $3.00
_.T OVERF LOWF NAGE Plf,DF2AfNF1ELD
FXTN,CES POOL,DRYWELL,MANHOLE @ $5-00 -
_- ____ HWY.0R ST,W'i LEN'NG _
I ALYE.R,REPAIR OR ABANDON HOUSE -_..
SEWER L' D Sw OSAL SYSTEM ._
- _ .. - I SENCROACHMENTCHMNT
_ PERMIT hi0..
i
INDUSTRIAL
WASTE 4F PRQ'YAL
OCHARS
WNER'S PERMIT z 00 I f -fir - - -�} -p-- -- -
CONNECT ION CA E FEE
AUTHORIZATION TOTAL FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NXMED CON- ---IM
---ItSEMEN7 F'EE
TRACTOR TO CONNECT 'SHE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLICSEWER. -�APPROYALS DA'r E INSPECTOR SiGNA'TURE.
SiGNEL7 THIS___-_--DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS AGEM1?T - -
— ----'— —' --
CONNECT ADDITIONAL i
BUILDING.OR WORK
ADORES$ _ -.
SEP7
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION /OTANK SEEP PIT(5)
AND ATE THAT THE ABOV 15 CORRECT AND AGREE TO COMPLY AND/1C
@RAiNF{E D I
WITH AL L COUNTY ORDINANCES AND STATE LAWS REGULAT!NG
PLUMB.NG AND SEWERS CESSP001, DRYW ELI_
P HEREBY CERTIFY THAT .IAM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF 5 EWAGE DISPOSAL SYSTEM
CALiFCRWA OR THAT I AM THE LEGAL.OWNER OF, AND INTEND 1.0 _D.
RESIDE N, DISCONNECT PLUG AND
THE ABOVE D LR;BfC RE5!CEN7IAL PROPERT I
ABANDON HOUSE EWER
OF' PERM -— BAC PLL SEPT;("TANKS [�
SSEEP,,PPT{S) [) CESSPOOLS
VALIDATION> _-,,. ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.o. <cnsH
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CE.8Ot
76AS4?"20 ,APPLICATION FOR PERMIT
COUNTYOF LOS ANGELES
DEPARTMENT
EN'P OFCOUNTY ENGINEER SEWER-SEWAGE .DISPOSAL.
BUILDING AND SAFETY DIVISION FORES
ICNN A. LAMBIE, County Engineer WILLIAM A. IENSEN, Supt of Budding °F FOR APPLICANT TO FILL IN-I EGAI
- °°�
D-FSCIM F t iON LOT NO f, OWNER . -� Fes`�„may-
ppyy `/
BLOCK TRACT MAIL ADDRF_SS
NO. OF BLDG5.
S)XE OF LOT NOW ON LOT '!TY TE.. NO-
DISTRICT NO. GROUP MAP PROCESSED BY
a- __._ ss ..._ .— — HK ,I 1
CONI RAC OH d'-y' .. _ 9 ✓�� __ "ki,.. _s � a:�� ti'...� ,�`'� .
ADDRESS -r"i y �.� j. ,e'er' <-;.' ,.--' "., CONNECTION ATA
/
_ �� -TEL NO8.-s STATION r /' DEPTH .. _..
ITY —F .__.- '--
—__ - ._ —._— � lv G 6.' _ -- — ❑C� STATE REGISTRATION NO. O—;NTY MANHOLE REFERENCE
NO, OESCRiPT7ON'OF WORK FEE lJ✓ �Jq � X J S,
= .
- --- ...- —
_ TYPE OF CONNECTION LENGI H FROM1;
I
HOUSE SEWER CONNECTI .
NG O Y. CURB P L F1.L TO P.L.
PUBLIC SEWER @ $5,p0 -__ ___
SEPTIC,TANK SFF.PAC- PIT OR -.-_-_ P O .NO _
�
PITS AND OR DRA NFICLD � $10,00
Cc !Ma NO, JOB NO
� '' �'
�!
H-OUSE SEVVER CONNECTING TO -TRUNK PER MIT NO_ ROAD PERMIT NO. ✓k C -
PRIVATE DISPOSAL SYSTEM _-_.-@ S3.00 r -�
QNNECT HUI'1SEWER
BDG OR - AFFIUAV r. WAIVER I EaS E�1.ENT__ ECORD. STR
I RtNNO.
_ . DAVE
WORK 70 HOUSE
L'SE SENEI2 C $3.00
_ - A
-__ ___ _._ _-_-_. _ _-_...—_-._
4v RFLOW SEF'PAGE PPT.DRAIN FIELD { I
EXTN
-CESSPOOL,DR -MANHOLE $.5-_.0__4
____ BAND-614
LI-B-LIER:REPAIR OR AHWY.OR ST.WIDENING �y.e
EV cR 4 C�SPOSA 5)Sft �^' _$_3.00 _____-_.__
_ — y.y... STATE.ENCROA CHMENT
0
PE MIT NO
__ _ _ - �.�____._.___-_—r—.—'•ti ___ INDOSTR.IAL
WAST"r.. FRaVAL
CHARGES y I;
OWNER'S PERMIT -----
__ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE -- -- - -- - ----- -- --------- ----
I HAVE, AT THIS DATE A CON S R.AC'T WITH THE HEREIN NAMED CON- REIMBUR MEN F E'
T R;ACTOR TO CONNECT THE ABOVE DESCR'.iEF.0 EXISTING DWELLINGr_—�.7
TO THE P iBLI- SF.IM'E F!.
APPROVALS I DATE I INSPECTORS SIGNATURE
SIGNED THIS----—__DAY O F_.__ ___ _-- __-- ----j----_-+---- _
OWNER 0R ��. s� NEW HOUSE SEVER
OWNERS AG E^1T_
CONNECT ADDITION.AI_ --.—^^
BUILDI
_NG OR.WORK
N
O/O TAMC.SEE IT(5)
Y HEREBY ACKNOWLEDGE THAT I HAVE READ TH15 APPL.I.,A 1'fCN AND%OR DRAINFSE�U I '
AND S'A?E THAT THE ,A
HOVE IS CORRECT AND AGREE TO COMPLY
NNITI, ALL. COUNT" ORDINANCE* AND STATE LAWS REGULATING �^
RLUMBiNG .A:VD S 'eN E RS,
CESSPOOL DRYWELL ❑ � 1
I HEREBY CERTIVY 'THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY U0S ANGLES COUNTY .AND STATE OF SEWAGE DISPOSAL SYSTEM
C'.ALf FOR,NIA. OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO —'-- ---" -"`--"---i"---'
RE
S
IDE IN.. TH ABO V'E DESCRIBED RESIOLNT!A I_ ?R OPE RT DI CONNECT PLU AND -I
ABANDON HOUSE EWER
SIGNATURE: BACKFILL SEPTI;,TANKS ❑
OF PERM.TT'7'E£ __=✓���_ SEEP..PI'T Ib) ❑ CESSPOOLS
VALIDATION,,---i.,, ROBERT A. WOOD
CK. M_O. f CASH
SUrERVISI-NG MECHANICAL ENGINEER -
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