HomeMy Public PortalAbout9084 OLIVE ST_Sewer__ 24530 INSERTS
60 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER r _
BUILDING AND SAFETY DIVISION ADDRESSG ' �+J �
WTO
A. LAMBIE, Coun Engineor
WTLLTAM A. JENSEN, Supt of Building LOCALITY '-
NEAREST
FOR APPLICANT TO FILL INCRDSS ST. ti' = -
LEGAL
DESCRIPTION LOT NO. OWNER
F1AIL
BLOCK TRACT � � ADDRE55 �� A J ✓ �- � x✓'"`'
0.OF BLDGS. An
SITE OF LOT ) NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP P OCESSED BY
BIC PG
CONTRACTOR ��_� ff r�y�gy
ADDRESS y's ' "�" CONNECTION DATA
CITY TEL.NO. .� dye- STATION DEPTH
❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. ❑ COUNTY LOWER
No. DESCRIPTION OF WORK FEE
HOUSE.SEWER CONNECTING TO
PUBLIC SEWER (v $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L,
1 PITS
AND/OR DRAI N FIELD @ $3.00
QOVERFLOW SE=.PAGE PIT'. DRAINFIELD
TN.-. CESSPOOL DRYWELL @ $2.00 --
HOUSE SEWER CONNECTING TO P.C.NO. -
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.I N0, JOB NO.
CONNECT ADDITIONAL PLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. W
WORK TO HOUSES SEWER @ $1,00 'i% OU
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT OG
SEWER OR DISPOSAL Si STEM CD $1,00 PERMIT NO, O
INDUSTRIAL E"
WASTE APPROVAL 5
CHARGES rn
OWNER'S PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I '_�ri , REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. ---
SIGNED THIS, DAY OF 79� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT - _ -�"- BUILDING OR WORK
d'DDRESS— 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 ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF ABANDONISCDISCONNECT
SE SEWERD
CALIFORNIA OR THAT' I AM THE LEGA OWNER OF THE ABOVE
DESCRIBED RESIDE TI L PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE
SEEP
.PIT(S) CESSPOOLS ❑
OF PERMITTEE
VALIDATIOO `g ROBERT A. WOOD
CII. M.®. CA5R ,/ SUPERVISING MECHANICAL,ENGINEER
'6A 6440-CF.80 -10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS �' r ,
LOCALITY
OZI
NEAREST
FOR APPLICANT TO FILL IN CRDSS 5T. - - �yJ�7 J
-DESCRGI TION LOT NO. OWNERIYJe �-47X�I A(.`!,✓ 0 V)7 •�
MAIL
BLOCK T ACT ADDRESS
NO. OF BLOG5,
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS_// ,�iy [ DISTRICT NO, GROUP MAP OCESSED BV
- BK p,
CONTRACTO
ADDRESS &._;-3�j .�. - CONNECTION DATA
CITY // 'C s7 STATION DEPTH�I� e, TEL. NO. � �/ /
STATE •"j/ �:.J LIC _ UPPER
.G7�- MANHOLE REFERENCE LOWER
LICENSE N CLASS _ >��
NO. DESCRIPTION OF WORK FEE _ TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER $7.00
SEPTIC (ANK.SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD $10.00 CO.IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO , d
PRIVATE DISPOSAL SYSTEM 0 $3.00 TRUNK PERMIT NO. ROAD PERMIT NOCL
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENt RECORD.INSTR.NO, DATE u
WORK TO HOUSE SEWER $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD OC
EXTN.,CESSPOOL.DRYWELL. $5.00 O
ALTER. )USE- - HWY.OR ST.WIDENING
SEWER OR DWU_0,5AL_SYSTEM $3.00_ - _ STATE ENCROACHMENT W
MANHOLE
Q $7.00 PERMIT NO. Q.
----- N
-- INDUSTRIAL Z
WASTE APPROVAL
OWNER"S PERMIT $1 3 00 CHARGES
AUTHORIZATION I TOTAL FEE /'y CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE IN5P TOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT -- "--
CONNECT ADDITIONAL y
ADDRESS BUILDING OR WORK
f- - -- ,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEPPIT(S)
AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL [IDRYWELL ElPLUMBING AND SEWERS.
I HEREBY CERTIFY I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS RED ED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH T I AM EI LEGAL OWNER F, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE, OVE DE CRISED RESIDEN L PROPERTY. ABANDON HOUSE SEWER
SIGRE �C BACKFILL SEPTIC TANKS ❑
OFF PER TEE_ _ SEEP.PIT(S) [, CESSPOOLS ❑
VALIDATION ( CK.;` M.O. CASH
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