HomeMy Public PortalAbout9147 OLIVE ST_Sewer__ 7EAf-2D
F.•G,63 12•S4 APPLICATION _ FOR ■ ERMI ■ ■
5 8 #fIF
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D 1 S POSA L
? Depa rtaient of County Engineer
County of Los NC�Ih1
Tir.ENGINEER
NGIeles DE�SG
"J°tlCef
, J. FOX, COUNTY I� E;at2 ADDR
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
LEGAL
DESCRtPT10N LOT NO . ,F— r j - _w OWNER
d" ` �e "- fns ,eV r•,taY
BLOCK TRACT `f' t 1-�!, MAIL
NO.OF BLDGS.
__SIZE OF LOT NOW 6N L01CITY - TELNO, �
USE OF .:_..�, _-
BUILDtNGS t – _ A— — DISTRICT NO. I GROUP � MAP
SK pG
CONTRACTOR0�__._.��..
ADDRESS CONNECTION DATA Y —
CITY I ;dl. - STATION 6 �� " DEP;H 6
STATE
a UPPERMANHOLE REFERENCE
NO. COUN .J '' _
� A`
TYPE O_�F. � r`ECTION LENG;s? FROM E
NO, I DESCRIPTION OF 1%IORK FEE _Y• "l UKt3' P. M.L.TO P.L.
p _I HOUSE SEWER CONNECTING TO
4 °UREIC SEWER _ tt $ 3. 0
i HOUSF�'EWcR CGfe PlEC7tNG 70 � i!
r2 VA7)<D PO iiL SY I ;-! 1.00 1 --
S i'tINEC7 Pllf`I iJ'vHL B,.DG. OR CO, IMP. NO �* ,'1';{' JOB. NO.
_ WORK-i0 HOJSF SF dER 1 OD - ..----
ALIER OR REPAIR °XISNN
FWF_R ORDISPOSAL SYSTEM _ � CO � ; .RUNK PERMIT NO. ROAD PERMIT NO
DI Cilli F, AldJ PuANDON SEINER STATE ENCROACHMENT .r c
AND/-CRSPOSA SYSTEM
---- --- _ERMIT NO,
S_,11VIC NX, St r G L PIT OR ------
P I-C S .ND O,2 RA;INFIELD_ ..�_ 00 .i.Ji NDJS'RIAL F
CtS - SOL Dh`<47C LL �' t°ASTE APPROVAL
C Ai COPD i 10N S ONLY 2 90 CHti `ti-3'
OWNER'S IIERINUT ._ —.--- S �f I 00_ - CONNECTION CHARGE FF
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THEE'.. ! t
ti E N NAMED. N
ge
7'P,ACt Cr. [O COI hE(.T THE ABOVE DE5C 19FD E'Xf.T.NG UJr ELL'NG APP k�OVALS DATE lNSP CI r2 S (.�P .,RE
TO THE PUBLIC SEWS-R
NEW HOUSE SEWER
SIGNED THIS —DAY OF__
OWNER ORCONNECT ADDITIONAL
OWNERS A0EN*-, BUILDING OR WORK
SEPTIC TANK, SEEP, PIT($)
ND/2R DRA;NFl_EL_D
i idEREdY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL
At;D STriTE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OP.
PLUMBING AND SEWERS. SEWAGE DISPOSAL S SYSTEMEOR
I HERESY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR — ISPOSA "–
LICENSED AS REOU?RED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR TEAT ! AM THE LEGAL OWNER OF THE ABOVE L�AN_DON-HOUSE SE'IILR _
DESCRIBED RESIDENTIAL PROPEoy. BACKFILL SEPTIC TANKS❑
SEEP_?IT(S) CI CESSPOOLS[I
SIGNATURE �- -
OF PERMITTEE -
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY
BY BY
® DEPUTY DEPUTY
642D -63
6A64E6 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES E
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION F
LD ING p 3 }'
RESS �L.f }
JOHN A. LAMBIE, County Engineer ; ^___
WILLIAM A. IENSEN, Sup'4 of Building ; r
ALPTYRESTFOR APPLICANT TO FILL IN SS 7. r _ -LEGAL
3
DESCRIPTION LC)T NO ��. �, r � OWNER
.�� -.
MAIL
BLOCK -1 TRACT �� �_ ADDRESS
NO OFLDGS.
-SIZE_Or LOT �_ J%J�'L NOW ON LpT e_ CITY TEL.. NO.
USE OF
BUILDINGS DIST'R ICT NO. Gft0vP MAF PROCESSED BY
—__- SK PG
CONTRACTOR
14-4-4 L / is't
_,s
ADORES CONNECTION DATA
� r ,..
CITY '.- TEL NO.
STATION.. DEPTH
} 4 E MlitNH.q L£REFERENCE 1 f T- UPPIE
REO.IISTRA ION NO. - } �: _F Z, _ V-CO LJ NTY ( F. 1 LOWER
NO. I DESCRIPTION OF W1RK- FEE —" TYPE OF'CONNECTION V LENGTH FROM
}tipUBE SEWER CONNECTING TO _YCURB P.L. ML, TO P.L.
PUBLIC SEWER $-5.00
_�-._.___-r_- P.C.NO. .g.�
SEPTIC TANK,SEEPAGE PIT OR : ..
PITS ANO/OR GRAINFIELD @ $10.30 j CO.IMP, NO. JOF NO.
P..
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM -
- t OM NCC:T ADOITiONAL BLDG.OR ------� -`---� -- AFFIDAVIT i WAtYL2 CA3GM iNT�_REC"ORD. iNSTR.NO. DA'Z'E. t
WORK TO HOJ E SEWER .. @ $3.00
OVERFLOW SEEPAGE PIT,ORA1N!'IEL.D
EX N.CE S OOL.DRYV4 ELL.MaN}TOLE $5.00 !;
HWY.OR ST.WIDENING
HOUSE_-.__..___ �
SEWER OP D4zvL35+.L' SYSTEM C� L
$3.OD `___ STAT'E ENCROACHMENT
PERMIT NO. -8.•
.NDUSTRI.AL
I. 'WASTg APPROVAL
. ." _
CHARGES
® NERP� PERMIT s 21 00
---- ——
AUTHORIZATION TOTAL FEE 4•^� ^ CONNECTION CHARGE FEE
IH AVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED ICON. REIMBURSEMENT FEE
T R ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING D'WELL..ING
TO THE PUBLIC SEWER. APPROVALS DATE 6NSPE.OTORS -.I G.NA' .RE
SIGNED THIS DAY oF. ._ ---_'-- -- --- --------�-- --'- --------
OWNER OR -_ _ __NEW HOUSE SEWER
OWNERS AGENT' _ CONNECT ADDITIONAL. _ --'-'}'---__._-_..
BU ILOI.YG OR WORK
S E I HFRESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. ANo/o.TANK SEEP PIT(S)- -"-� -
ANU;'pR DR A:NpI E..b
AND TATE: ThiAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WIT H AL,L O TY ORDINANCES AND STATE. LAWS REGULATING
PLUMB NAND SEWERS. CESSPOOL ❑ ORYWELL ❑ II _�
I MERFBY CERTIFY THAT ', AM PROPERLY REGISTERED AND/OR ALTFR..REPAIR,SEVER OR
I.CENSED AS RE .U!RF0 BY LOS ANGLES COL NT'Y AND STATE OF SEWA,GED DM-PCSL SYSTEM
C:ALIFORNIA OR THAT ( AM .THE LEGAL. OWNER OF
hAND INTEND TO DISCONNECT PLUG AN
R ESIOE IN, THE ABOVE. DESCRIBED RESIT NTiAL''P,OPERTY.
+ - �� ABANDON HOUSE SEWED! I
SiGNATU RG ACKFII I S' c_�
`` B SEPTIC TAN
OF PFRMiTTEE - _ __ � ._ _ ._ 9..__<.._�.1,=" --- _ SEEP,PIT fS) C' cESSFOOLS ❑i
VALIDATION ROBERT A. WOOD
C;K),j M-O. CASHSUPER`✓ISiNG MECHANICAL ENGINEER