HomeMy Public PortalAbout9166 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEW.AG E DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ABUILDING
ODRESS t 1ye
FOR P//LICANNT TO FILL IN LOCALITY-
AI
DDRESS / 6... v +/r� NEAREST' J
CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST f A 1502 S
_
CROSS ST. `G'��f
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER C9i9 L. � /� �' 9 -
-1 53
ADDRESS ] G� Cly Jye�' .. USE ZONA OCCUPANCY . MAP PG
CITY �� TEL.NO. I .. CLOL
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C0NTRA0T0RRR1.� 4R , yL /_ �GO..IMP.NO. I ~ ) r A
ADDRESSJf,JCR:j6 ,lJ`4CY .94 PO. _
JOB.N0.
CITYi �C' ��- TEL:NO��'%������y TRUNK PERMIT NO.
t7� STATE
REGISTRATION NO. a Y Fi0'AD PERMIT NO.
LEGAL �+ E'ENCROACHMENT_,.-.._..
DESCRIPTION LOT N0. STAT
�i t, / PERMIT NO.
BLOCK TRACT `/ / C� INDUSTRIAL
y WASTE APPROVAL
SIZE OF LOT I�- /� NO.OF BLDGS. J
LT NOW ON LOTUSE O
. / CHARGES'
BUILDINGS �.� !� COHNECTI ARGE FEE A
NO. DESCRIPT113N OF WORK FEE
_ -REIMBURSEMENT FEE -- •��'' - "- `- -=-'- -
HOUSE-SEWEWCONNECTING TO
PUBLIC SEWER' ! $ 5.50 RECEIPT NO. I E BY
HOUSE SEWER CONNECTING TO �®e
PRIVATE DISPOSAL SYSTEM - 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED��
WORK TO HOUSE,SEWER 1.00 NO.
ALTER OR REPAIR EXISTING I DATE I BY
SEWER OR DISPOSAL SYSTEM I:00
DISCONNECT AND ABANDON SEWER '
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK',.SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD 2.00. STATION G429 �� ' DEPTH
CESSPOOL—ORYW ELL
SPECIAL CONDITIONS ONLY 2.00 -Ian' mlr MAN}1 PER EFERENCE
TYPE0 MOTION LENGTH FROM
CITRBaj M:L.TO P.L. /4?OWNERS PERMIT $ 1 1. do; _
AUTHORIZATION TOTAL FEE I S�
I HAVE THIS DATE CONTRACTED WITH.THE HEREIN NAMED
CONTRACTOR.TO.CONNECT THE ABOVy DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE//P�UBLIC EWERC SIGNED THIS..-� dm
_I9� NEW HOUSE SEWEROWNER OR CONNECT ADDITIONAL
OWNERS AGE T...... BUILDING OR WORK
9 - - SEPTIC TANK,SEEP..PIT(S)
ADDRESS=_.. _J- A1.:!d' ...d ! AND./OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL. DRYWELL❑
CATIONAND 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 DISPOSALSYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY 'REGISTERED DISCONNECT PLUG AND
AND/OR LICENSE AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE-SEWER
AND STATE OFC LIFORNIA R THA AM THE LEGAL OWN-
ER OF THE A1-k-LE-1
E DESC D R NTIAL ERTY. BACKFILL SEPTIC TANKS'[]
r�JJ SEEP.PIT(S)E] CESSPOOLS
OIF PERMRTTE �lR_.. .-- _. T .. .
76A643D 663 1/53
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