HomeMy Public PortalAbout9432 OLIVE ST_Sewer__ 868 Jaes'� APPLICATION FOR I T �
COUNTY OF LOS ANGELS SEWER—SEWAGEDISPOSAL..,
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
JOHN A, LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building
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VALID LION ROBERT A' WOOD
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S LJ—EF2V!Sf[�t,S.. MECH A�.. ICAL ENGj-NEER
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Y6A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
M
BUILDING AND SAFETY DIVISION BUILDING
WIOHNA. LAMBIE, County Engineer ADDRESS r
LLIAM A. IENSEN, Sup" of BuildingADDRESS
LOCALITY
IQ �e
_C4 ty
FOR APPLICANT TO FILL IN 1'emple City Blvd.
DESCra PT.ON ON L: T N Ojit --NER
MAIL
E_'-7 'X- TRACT "I'm"S' 9 4312 Olive Street
NOOFHLOGS.
SIZE OFLO' NOW ON LOT CITY NO.
USE OF
BUILDINGS Residence OE)DISTRICT NO. GROUP MAP PROCFEBY
BK PG
CONTRA 0
J - _
ADDRESS 51 N. Third Avenue CONNECTION DATA
CITY Arcadia TEL_NO.447-8135 STATION DEPTH
STATE MANHOLE REFERENCE, Ell
REGISTRATION NO. _THClO U-NT Y
Nod DESCRIPTION OF WORK FEE, TYPE OF CqjLfSECTION LENGTH F40NI
SINGTO 0
Y. P,L, M.'_T
PUBLIC SkWER St.00 (A)
SEI:'TIC TANK,SEEPAGE PIT OR PC.NO.
-1. 'j jOB NO.
PITS AND/(R 0 RA I N F I r'L D s90.00 CIMP.NO, '6:
W-ER CONNEC T I NG TO
7
E
TRUNK PERMIT NO. ROAD PERM li0
FRIVA DISPOSAL SYSTEM $3.00
. -----7- - - --- -TER-
CONNECT ADGil ONAL BLDG.OR AFFIDAVIT WAIVER ZA$ITMENT C
WORK TO HOUSE SEWER @ $Zrloo RECORD. 0. DATE
OVER
F LOW SFErAGE PIT,DR.AiNFIV-D
FXTN,,,CESSPOOL,DRYWFLL,MAN}4OLE $5.00
HVI'Y.0 R S T WID.E N I V,G
:T ALY SE�VVE�0 --A ME�NT
R DISPOSAL SYSTEM $3.00 _-ST-ATE EN�CRO CH -------
PERMIT NO.
INDUSTRIAL.
WASTE APPROVAL
wS
21 00 — ____
OWNE RMIT $I - I— _ _____ __CHARGES
A UT H 0 RIZ A TI 0 N I 0—T-A-L---FE—E —1 _____ CONNECTION CHARGE FEE
7,00' -
I HAVEAT* I.HIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RLjM_sw!sFmFNT FEE
T-ERACT 0 P TO CO 4NECT Ti iE AE30VE DESCRIBED FXJSY'NG_2. WELLING
To THE PUBLIC SL ER APPROVALS I DATE INSPECTOR'S SIGNATURE
SIGNED THIS -DAY OF!----.
OWNER OR N W HOUSE SEWER I.
OWNERS AGENTS
CONNEC T ADDITIONAL
BUILDING OR WORK
ADORES$_ C, K,S___EE P.'WiT fS
5EITII, T"AN
AKNOWLEDGE THAT I HAVE REAL' THIS APPLICAIION A r;im_"C:P,
-IEL.D
OF �3
AND STATE THAT THE ABOVE 15 CORECT AND AGREE. COMPLY A-IN-F----
WITH A(,L, COUNrY ORDINANCES AND STATE LAWS RFrULAT4NG
'LUNG
ING ANV SEWERS. DRYWFLL
REB
H Y CVWTIFHAT I AM PROPERLY REGISTERED AND/DR ALTER,REPAIP,
F _V TSEWER OR
LICENSED AS REOJIRED BY LOS ANGLES COUNTY AND STA'TE' OF SEWAGE DiSP09AL SYSTEM
r AM THE LEGAL OWNER OF, AND INTEND TO
CALIF C'RNiA OR THAT
RESIDE IN, THE ASO, DISCONNECT PLUG AND
,�E?DESCR155P RESIDE J�ROPERTY, ABANDON HO SIL rEINFR
SIGNATURE
TEL -BACK
FILL SEPTIC TANKS
SEEP,PIT-) ❑ CESSPOOLS
VALIDATION ROBERT A. wOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
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