HomeMy Public PortalAbout9328 OLIVE ST_Sewer__ E808 5.65
642 0 APPLICATION FOR PERMIT
6A 64
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING : / ✓
101I7NA.L ANIRW, C,unty Fnpiutvsr ADDRESS
CUFMAti W. JP KI�5, Fun't, of L3uilding /
LOCAL TYA� ='T7
NEAREST
FOR APPLICANT-TO FILL IN CROSS 5T.— _
—_.LEGA.-L �___.__
DES^.RIP71C N _ LOT NO. ._ __-- OWNER
I
MAIL
I > ,
BLOCK TRACT 7 - ADDRESS T
NO. OFBLDGS- � —_
SIZE OF LOT NOW ON LOT_-_ NO.
USE OF - DISTRICT NO- GROUP MAP PROCESSED BY
J
BK PG
CONTRACTOR,.^"~r� � -.Y" / ����` ff r f/r• ._�...; _
ADDRE55 t CONNECTION DATA
C1 TEL !¢' -�,P "' STATION DEPTH
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NOCENSE = SSE '' ,.% •r p UPPER,;
{L/«.([«««_. JL'� MAN H OLE,REFERENCE
wo
NO. GES IPT10 OF WORK FEE _ TYPE OF(OFXN4TION LENGTH FROM
}tf OUSE SEWER CONNECTING TO �— Y. CURB P.L. M.L.70 P.L.
"
PUBLIC SEWER $ 5-00 ----- - 4--
EFTI TANK. SE EPA-E FIT OR _CO.IMP.NO. JOB NO.. O
PITS AND,OR DRAINFI ELD $10.00
HOUSE SEWER CONNECTING TO —�
TRUNK PERMIT NO. ROAD PERMIT NO. V
PRIVATE LISPOSAL SYSTEM $ 3.001
CONNECT ADDITIONAL BLDG. OR AFFIDR VIT WAIVER EA�CNLNT RECORD. INSTR.NO. DATE /C°
WORK TO HOU E SEWER $ 3.00! =�1 i+; 1-'; 0
- A-C.FE`�--HF.�SI �A f3A NbOY HOUSE �._��
SEWER OR DISPOSAL SYSTEM 4 $ 3.00 - W
VE7FFLR'k'-�'"E-?AO` T'Y'� ATFIF7'ECb -� HWY,OR ST.WIDENING
j E%TN.,CE POOL, MAN1CLE _�.- $ 5 00
-+- - - __ -r----_..-._— STATE ENCROACHMENT
PERCOLATION TEST $ 5.0C PERMIT NO____G- 6'.t..J'l "�" � �..,,. �_� _ Z
---------------- t---j--- INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT _Y �' 2CHARGES 00 —— --- --
CONNECTION CN
AUTHORIZATION TOTAL FEE� -- -- --- --- - � �------
'I HAVE AT 'THIS DATE A CONTRACT WITH THE EREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBE EXISTING DWELLING ------ — --+-- '--
TO THE PUBLIC SEWER. APPROVALS DATE
INS 'I SI GNATURE
SIGNED THIS --"----
_.
OWNER OR yfJjC�Ir/ NEW HOUSE SEWER_
OWNERS AGENT__ CONNECTADDITIONAL ty
ADDRESS BUILDING OR WORK
I HFREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP.PIT(S)/
IT(S)
AND/OR ORAINFIELD -}---
AND STATE THAT THE ABOVE is CORRECT AND AGREE TO COMPLY
WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDi OR ALTER,REPAIR,SEWER OR
LICEN�PNl
S REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIF OH THAT I AM Eyy,,LEGAL OW -I:OF. AND'INTEND TO _--- -"— ----'-
RE51 Ti, OVE D "Rita ED RESID TIAL P P 4� DISCONNECT PLUG AND
,,rr ABANDON HOUSE SEWER i
GfF'P •�� BACKFILL SEPTIC TANKS ❑i
❑ CESSPOOLS
V IDATIO�I�T--- -
CK. M.0, CASH
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76A;8dz�� APPLICATION- FOR PERMIT
76A s
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER -ADDRESS
COLEMAN W. JENKINS, SUPT. OF BUILDING '
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CRASS sT.
LEGAL - { -
DESCRIPTION LOT NO. OWNER
`� MAIL r
BLOCK -TRACT ef'y,r �- ADDRESS
,e+ p NO.-OF B=LDGS. / .- *� _LYC.L_
SIZE OF LOT { Irl. NOW ON LOT CITY/ . ' TEL. NO. vile 6
USE OF �_-- _
BUILDINGS �'�"y J %'. _DISTRICT NO. GROUP MAPK P. PROCESSED$Y
/�." -
CONSRACYO � f k.:.:-___.L_ '�- ✓✓c.a VJ ' � �`4f�'v�"ICG'6'll�'�!
ADDRESS '? 7 7 6 '' CONNECTION DATA
�f f STATION DEPTH
TEL. NO. i� // !�y-
CITY '_�1�. `�.�'�'i.J✓�aL �," � ��✓ ___ ✓ y
STATE LIC
LICENSE NO, JCLASS
__ MANHOLE REFERENCE
LOWER
SCRINOFNO. DE ��
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO �T- Y. P.L. M.L.TO P.L. �J
PUBLIC SEWER -$5-00.__I --- P.C.NO c
SEPTIC TAN K- SPAGE PIT OR �m�,� ,�
PITS AND(OR DRAINFIELO �. $10.00
PRIVATE DISPOSAL SYSTEM $3.00 CO..IMP.NO JOB NO.
HOUSE_R_
EWER CONNECTING TO -T _-- --- - - -'- --a--_-
TRUNK PERMIT NO. ROAD PERMIT NO. �_
1 � � Q
_ _— _._ —._._ _ v
.CONNECT ADD TIbNAL BLDG OP2 T.�—�—_-._ -- AFFIDAVIT ! wAIVEY EA$EM EN! RECORD.iNSTR.NO. DATE
WQRK TO HOUSE SEWER - 0 53.00
O VERF
LOW
SEEPAGE PIT.ORA NFIELD � � _
I EXTN..CE5SPOOL.O RY WE L.MANHOLE @ $5.00 CD
_a.4. -.__ t_._ __._ HWY, OR ST.WIDENING ~
� BANDON HOUSE („3
SEWER OR DISPOSAL SYSTEM. _ $3.00 _ �� _ STATE FNCROACH MENT
PERMIT NO. C/J
_4 ' I--- INDUSTRIAL
WASTE APPROVAL
CHARGES
O` MERrl3 PERMIT $1 21 00 -------..�.. __.-- --- ------
AUTHORIZATION] TOTAL FEE ��-_- CONNECTION CHARG EAFEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO-.CONNECT THE ABOVE DESCRIBED EXISTING DWELLING: ----- --- ECTOR-------
TO THE PUBLIC SEWS DATE INSP 'S SIGNATURE
SIGNED THIS DAY OFAPPROVALS
OWNER OR . /...� NEW HOUSE SEWER
OWN ERS
WNERS AGENT CONNECT ADDITIONAL
ADDRE55 �."y.._ � _, }�_ � BUILDING OR WORK
-- SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY —. ______
WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEW ERS. CESSPOOL ❑ ORYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM A +'
CALI FORMA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO - —PL-- — j - '4
6 SCONNECT-PL(1G AND
RESIDE IN, THE W."i
CRIBED RESIDENTIAL PROPERTY. 'ABANDON
HOUSE SEWER— J ✓� !S
51GNATUP.E ,/�. � - �_ BACKFILL SEPTIC TANKS ❑OF PERMPTTE I, 6 llll s ..,- ,G s-
--- –-- SEEP.PIT(5) ❑ CESSPOOLS ❑ -_
VALIDATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
PCK.'/ W O CASH
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