HomeMy Public PortalAbout9333 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEINER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING .d ,� T
ADDRESS .'� I,.:; L `t, I e r _ CROSS ST.
LOCALITY "` y "
DISTRICT NO. SERIAL NO. PERMIT N0.
NEARESTr A S
CROSS ST.
y7 + RECEIVED BY Ready for Inspection V DATE ISSUED
OWNER
MAIL t; USE ZONE OCCUPANCY
ADDRESS ty, Y �1. .,•.,
_ BK PG
CONTRACTOR -
_�. -- CO.IMP.NO.
ADDRESS "
JOB NO.
CITY a r
TRUNK PERMIT NO.
REGISTfiATION NO.
H STATE
COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT
1 �� j. PERMIT NO.
BLOCK TRACT r` _
INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO.OF BLOCS.
:. �. 7.E r- NOW ON LOT CHARGES
USE OF
BUILDINGS - J i ^`' CONNECTION CHARGEf'EE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO I REIMBURSEMENT FEE
PUBLICSEWER G+7 $ 3.50 _ RECEIPT NO. DATE f BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
a CONNECT ADDITIONAL BLDG.OR EXCEPTION REC,9RDEO
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- DATE f BY
SEWER OR DISPOSAL SYSTEM 1.00 1
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 3` ^' DEPTH
CESSPOOL—D RY W E L L --
SPECIAL CONDITIONS ONLY 2.00 _ MAP!:S 'r^,EFERENCE
UPPER-. LCC WEtii
TYPE OFC.'."SCTION LENGTH FROM
OWNERS PERMIT $ _1. 00 Y: CU � M.L.ro P.L.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO TH PUBLIC SEWER APPROVALS INSPECTORSSIGNATURE DATE
r.
SIGNED THIS._.: �, .,.._DAY OF----L,<_..i:. �._._...___....19.�.:� NEW HOUSE SEWER �, •:;.: F,,, ;��.
3
OWNER OR �� nyl CONNECT ADDITIONAL
OWNERS AGENT_._'-:-_- ... ..r.:tM!i' _..r-.. _.:... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS .................•-__ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL❑
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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL-PROPERTY ,P; BACKFILL'SEPTIC TANKS
D
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE ° y p Y
OF PERMITTEE_.-
76A642D 663 1/53 �'a