HomeMy Public PortalAbout9093 OLIVE ST_Sewer__ �S
r
24690 INSERTS
76A
642°.60 APPLICATION FOR PERMIT
'sA�R� COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, County Engineer
'WILLIAM A. JENSEN, Supt at Building � LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cRoss sr.
LEGAL - � -
DESCRIPTION_ LOF N0. OWNER,
BLOCK a TRACT � � MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL, NO.
USEOF
BUILDING DISTRICT NO. GROUP MAP PROCESSED BY
BR PG
CONTRACTOR
ADDRESS - ;:fi CONNECTION DATA -'
r
CITY y TEL.Nfl. L'y STATION k' — DEPTH
))) TEMANHOLE REFERENCE UPPER
R_F_GISTRATION NO. �<1z COUNTY -- "LOWER
NO DESCRIPTIO 'O WCFR-K FEE
i NOtjSE SEWER CONNECTING TO
/ PUBLIC SEV FPR (; $3:�^*J- TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIE.LD $3.00.
OVERFLOW SEEPAGE PIT,DRAINFIELDY,.
EXTK..CESSPOOL. DRYWELL C $2.00
HOUSE SEWER CONNECTING TO P.C.JOB NO.
RIVATE DISPOSAL SYSTEM @ $1,00 CO.IMP, N0. z - 1
{ CONNECT ADDITIONAL,BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0.'f ,if O
WORK TO HOUSE SEWER C� $1.00 `y
ALTER,REPAIR OR ABANDON HOUSE .STATE ENCROACHMENT py'
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO, 0O 8
INDUSTRIAL
- WASTE APPROVAL N
CHARGES
OVMER',S PERMIT 3 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS AY OF' 18— NEW HOUSE.SEWER
OWNER OR .. CONNECT-ADDITIONAL,
OWNERS AGENSUILOING OR WORK
SEPTIC TANK,SEEP.PITS)
ADQR:.',SS`_ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE )S CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL. ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR.SEWER OR
PLUMBING AND SEWERS, SELVAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUI%RED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CAL.i ORNIA OR THAT I AM 'HE EGA IWN THE 'ABOVE ---
DESCRDESCRIBED RE5IDEN R ,� BACKFILL SEPTIC TANKS Ej
IBED -- SEEP. PIT($) CESSPOOLSSIGN ❑
TURE
OF PERMITTEE ,J
y . VALIDATION ROBLRT A. WOOD
cK. N.0, CASH SUPERVISING MECHANICAL ENGINEER
x
24650 INSERTS
1 ~`
CE808 6.60 Frazp
�eA - APPLICATION FOR PPERMIT "
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL l
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION C/,uG
ADDRESS
IGFIIV A. L MBIE. Countg Sazggirasar
ILLIAM A. JENSEN, Snp't of$ulldrug LOCALITY
NEAREST'
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL — f
DESCRIPTION LOT NO.� OWNER
BLOCK r .. TRACT MAIL
ADDRESS
NO.OF BLDGS.
[NO.
IZE OF LOT NOW ON LOT ✓ '' CITY TEL. NO.
BUILDINGS
/ DISTRICT N0. GROUP MAP PROCESSED BY
l_II LDINGS
_ BK PG
ONTRACTOR. - - -
j
DDRESS CONNECTION DATA
ITY TEL.NO. ' STATION , DEPTH
'. MANHOLE REFERENCE - - UPPER
EGISTRATION 1Q0. ° -� CO11N7Y -" ®"LOWER.
I DESCRIPT'ON OF WORK FEE
HOUSF.SEWER CONNECTING TO :I -
PUBLIC SEWER (W $3.00 - TYPE OF CONNECTIONS LENGTH FROM -
SEPTIC TANK,SEEPAGE PIT OR CURB P.L. M.L.TO P.L, Y
PITS AND/OR DRAINFIELD Ca $3,00
OVERE'LOW SEEPAGE PIT. DRAINFIELD. ..
EXTN., Cr55POOL,DRYWELL C $2.00
HOUSE SEWER CONNECTING TOC,NO.
PRIVATE DISPOSAL SYSTEM @ $1..00 CO.IMP, NO, ,t ' r� LB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO k10U5E SEWER @ $1.60 TRUNK PERMIT NO. ROAD PERMIT N0.-i' •r
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT DC
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. O
INDUSTRIAL
WASTE APPROVAL W
CHARGES to
OWN&S PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE °) r 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 19- NEW HOUSE SEWER I _
OWNER OR CONNECT ADDITIONAL j+
OWNERS AGENT— — BUILDING OR WORK _I
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRA.INFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL [DDRYWELL ElWITH 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 ANG ,ES COUNTY AND STA' OF ABANDON HOUSE SEINER
CALIFORNIA OR THAT I. AM TIJE L� AL NE TH eOVE
DESCRIBED RESIDE." - DP Y BACKFILL SEPTIC TANKS []
S P.PIT(S) CESSPDO S L3
SIGNATURE -
OF PERMITTEE
�s // -VALIDATION ROBERT A. WOOD
CK. U,0. CASH SUPERVISING MECHANICAL. ENGINEER
$ n.A 116 mss' 5.0 fid' f,F.
r