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HomeMy Public PortalAbout9150 OLIVE ST_Sewer__ '6A6420 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FAEC�,DRESSILDING �y JUL&IN A. LAMBIE, County Engineer _WILLIAM A. JENSEN. Supt of BuildingCALSTYA FOR APPLICANT TO FILL IN CROSS ST - LE AL IZSCR I PT 1 ON LOTNO �' OW.NER .'. MAIL --- �— ---- BLOCK TRACT --yry' ADDRESS } NO. OF BLDGS.. _ NOW ON LOT CITY 51'•E LOT NOW USE: O BUILDI - .''. am r )y y, DISTRICT PJ O. iROi:P MAP PROCESSED BY ail "- I-_Ind ID 0-e BK PG COT14TRA._TOR ADDRESS - CONNECTION DATA CITY TEL NO. .STATION DEPTH. ❑ STATE REG;bTuATION NO. [] COUNTY MANHOLE REFERENCE No. I DLSC.RIPTIONI Of WOR.h{ l TYPEE OF CONNECTION LENGTH FROM HOUSE SWER CONNECTING TO � Y. CURB P.L. M.L TO P.L. �. i PUB IC SEWER �L+ $ '.00 -_--_ P.C.NO E.FT IC TA' dK E.PAGL PIT OR - riTS AN .O -P DRA1NFIELD $90.00 CO.IMP NO JOB NO. s '> SCW N CONNECTING TO SAIVATE D f OSAL SYSTEM @ $ 0c) RUtJK PERMIT NO. ROAD PERM'?NO. TO HO IE SEWER Q $CONNk CT ADDITIONAL @a.1c,'-"'z WORAF+!DAVIT T w.alVrd EASEMENT I REi/ORl7. NS NC. T DATE M. C3 i i 00 OVERFLOA'SEFFAGE Pil,DRAINFIELD XTN CE.SSrOOL,LRY WELL.MAN HOLE $u.00S HWY.OR S7.WIDENING A.L.FER..REPAIR OR ABANDON HOUSE � SEWER Q S' A D' -POSSYSTEM $3..00 __.__..-__. -.r __...._ —__.. _ STATE ENCROACHMENT _ 1 PERMIT NO. ! ---y--'----' IFdDJSTe2IAL ' WASTE APPROVAL -. OXVNY.eIi`w7 PERMIT ' 2'� 00 --ter--"c-'.F r_ f- __... --� _____.- CONNECTION CHARGE Fft AUTHORIZATION TOTAL FE ------- 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE. f RAC OR TO CONNECT THE ABOVE DESCRIBED EXISTING OWELLING _D—/_��/ !_ s.O� THE PUBLIC SEWER. APPRO YAL DATE. INSPE'.CTOWS SICNATU.P9iE SiGi`(E© THIS DAY -OE'�.------- '1�--- OWNER OR NEW HOUSE SEWER OWNERS AGENT—,--- _._ CONNECT ADDITIONAL A DCR vS,- BUILDING OR WORK SEPTIC TANKSEEP,PIT(S) HER BY Ar K?`OWLEOGE THAT I HAVE READ THIS APPLICATION AND/OR DRAIN,-'IELD i B THE AGVF_ IS CORRECT AND AGREE TO COMPLY AND STAT— THAT l c ` fESSPOOL-C]__DRYWELL WITH ALL C.OUN7Y ORO iNANCES AND STATE LAWS REGULATING I PLUMBING AND SEWERS ❑ ------- IPERrSv CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER. REPAIR,.SEWER OR L CENSEr A: REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE D;SPOSA YSTEM II AL;FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO ._—_.DN DBA HN S JG AND THERES:DE IN. THE ABOVE DESCRIBED RESIDENTIAL. PRGP. TY. I ABANDON ]USF SEWER SIGNATURE _ E __ BACKFiL L SEPTIC TANKS Oi PERMITYE _ -- SEEP,PIT(S) ❑ CESSPOOLS ---VA ID TION ROBERT A. WOOD CK. M.O, CASH SUPERVISING MECHANICAL ENGINEER %' DEPAIVrMENT OF C0UNTY ENGDVEER SEWER--SEWAGE 0ISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES GUILDING WILLIAM J. FOX, COUNTY ENGINEER ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDINGNEAREST ADDRESS .F / r) - — id �z.� CROSS ST. --tom — LOCALITY � f DISTRICT N0. SERIAL N0. PERMIT NO. tY y S NEAREST CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUES) OWNER MAIL USE ZUNI OCCUPANCY BK MAP ADDRESS PG yf f 13J +e ` CITY TEL.NO. —`y f CONTRACTOR n J CO.IMP.N0. �, 7 7 e� ADDRESS / ✓ ems] ��f d 7 JOB N0. CITY -A, - TEL.NO.�� t�i'LiC r -< TRUNK PERMIT NO. REGISTRATION NO. L c" STATE � ,1'a� 1 j' ® COUNTY ROAD PERMIT N0. LEGAL f` _ STATE ENCROACHMENT -" DESCRIPTION LOT NO. z PERMIT N0. BLOCK TRACT 7 INDUSTRIAL ,—�� WASTE APPROVAL SIZE OF LOT N0.OF BLDGS. CHARGES,' ,� t✓ .^`j � !� NOW ON LOT G USE OF ,, �� CONNECTION CHARGE FEE BUILDINGS /Z' ��. _ NO." DESCRIPTION OF WORK FEE REIMBURSEMENT FEE t HOUSE SEWER CONNECTING TO ] — 1 PUBLICSEWER @ $ 3.50 _ U" RECEIPT NO. DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLOIS.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO- i DATE I BY _SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.000 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR �— _ PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL f SPECIAL CONDITIONS ONLY 2.00 ✓ ANkOLE REFERENCE 1 UPPER 's'- , LOWER TYPE OFC R�ONNECTION LENGTH FROM y OWNERS PERMIT ; oo M.L.TO P.L. AUTHORIZATION I TOTAL FEE I 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.__.. ..........I?'11 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL L� OWNERS AGENT-..,._,.._.. BUILDING OR WORK SEPTIC TANK.,SEEP.PIT(S) ADDRESS...::..... ... .. . ... . .._.. ._. . ..-.---..-.'t............. AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL D CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- USESEWER ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S)E] CESSPOOLS E]J A 11 n y r 3 & .. OF PERMITTEE.. ....._.._._s _..,t_ `" 76A642A 663 7/53