HomeMy Public PortalAbout9520 OLIVE ST_Sewer__ MA62 1°`e PPLICATION
4FOR PERMIT
7 Ya 6 9
COUNTY OF LOS ANGELES SEINER-SEWAGE DISPOSAL_.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LANIBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup'€ of Building
LOCALITY
NEAREST zi
FOR APPLICANT TO FILL IN r, RL>56
y-- _w�.� _ ._a✓�. .�_-dam. t
L<iT"'7 �� OWNER
DES:P Nr ON � ____ -- 'X..lfc-r=-7' t_-?,.,-^•r,.
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NO. OF rBLDGS.
SIZE OF LOT N'?1W ON LAT CITY TEL, NO'.
USE OF
BUILOIN!3S DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACT
ADOR SS � � �p s£� � � �' ` CONNECTION DATA
CITY ask �.=£r, .,'[SEL NO. e' ✓ STATION DEPTH
,�p']'s�?p' d '
TATE—
^' MANHOLE REFERENCE
R£G"tSTRATiON NJ ,ro L� COUNTY
NO� .JE�CRI oTIONF"'�hlnRt F£E TYPE OtON N.�CT{OA1 s-- LE FROM O
.LOW R Gy,
-- LENGTH
HOUSE SEWER CONNECTING TO _--- + Y ,/CyJRB P L. M:L-TO P.L. C,D
PUCL CSEWER �' $5.00 j - _ --- `— — - '
( SEPTt TANK SEEPAGE PIT OR NO,
___j
PITS AND OR DRAINF ELD @ $10.04 GO_I-MP NO �_ _ J09 NO,
NOUSE SEWER CONNECTING TO --. _--�}- TRUNK PERMIT NO. __—ROAD PERMIT Nb..r- L)
PRIVATE DISPOSAL.SYSTEM @ $3.00 LU
~ CONNECT ADDITIONAL BLDG OR AFFiDAY(7 1Vn1VER l_FaSEX Ehr ' RECORD.INSTR NO. DATErL
WORK TO HOUSE SEWER $...DO
O�'c RFLOW SCEPAGE PIT DRAiNFIELD
EX N.,CESSPOOL,DRYWEL L,MAN H OLE $5.00 -� -
____ .—.. _b _—_ _-�-___ HWY.OR S7 WTDEPtING t
i ALTF�'.,RLPAtR OR ABANDON HOUSE �-� I
SEWER
OR DISPOSAL.SYSTEM $3.00 STATE'.ENCRO -HMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGE
OWNER'S PERMIT �� 2i 00 -- -- —---- — --— --------
-- -^ -- -- = CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
1 HAVE.AT THIS DATE. A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
Lf NNFCT THE ABOVE DESCRIBED EXISTING 6iNELL.ING
TRA;CfiOR TO `.t _
10THPUBti C SEWER. APPROVALS f DATE i INSPECTOR'S SIGNATURE
SIGNED T4-{iv DAY
OWNER OR NEW HOUSE SEWER
OWNERS.ACFN?*,__-._—___.____—__._,_...-- __ _____._.. ____-__
- --' CONNECT ADDiT/ONAL
BUILDING OR WORK
ADDRESS_.__
SEPTIC TANK,SEEP,PIT(S)
I HEREBYACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND,OR DRAINFIELD
AND STAT THAT THE ABOVE iS CORRECT AND AGREE TO COMPLY
WITH ALL. COUNTY ORDINANCESAND STATE LAWS REGULATING � 4
PLUMBING AND SEWER$., CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THA-' i AM PROPERLY REGISTERED AND/OR ALTER RE AI.R,SFWE.R OR - --------,---
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALI'FORN IA OR THAT i A7 THE LEGAL OWNER OF, AND INTEND TO
RES DC IN, THE RBOY"E. DERiSED RE516 ENTtgI,I PROPERTY. ABANDON HOUSE SEWER
DISCONNECT PLUG AND
SIGNATURE �'� � I
�. x; � ,fp E�.er BAC KF!LL SEPZ"IC I ANKS Li I -1
�f.f
O_ PERMIT ._ :�'
SEE.,PIT(S) CESSPOOLS �
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
_ CK.'; M.O. CASH 4�°q 7
V
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76A64.2D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
D
JOHN A. LM
ABIE. County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building
LOCALITY
ALITYNEAREST
___
12 1 4
S
FOR APPLICANT TO F1LL IN CROSS T
LffiYAL '0
v Es CR.PT-0 0 N LO 0, OWNER
BLOCK T
-T
LOT, _nW ON T CITY TEL, NO.
USE OF
BUILDINGS DISTRICT NO, GROUP MAP ROCESSED By
P
BK G
CONTRACTOW
77
CONNECTION DATA
ADDRES
TY
STATfO DEPTH
_EL, NO.
CI
; ""'STATE; MANHOLE REFERENCE J
REGISTRATION N C3 COUNTY Q.
DES/ RIPTION OF WORK
TYPE..OF CRNNEC.TIQN LENGTH.FROM U
Y. P.L, M.L.TO P,L.
NOUSE-SEWER ONNEGfING TO
PUBLIC SEWER $5..00 xo_ P.c
OR
SEPTIC T kw�c' NO.
PITS AND/OR DRANFIELD C 0 TMP NO__ jos NO, 0
HOUSE 'EWER CONNEC�TING TO TRUNK PERMiT NO. ROAD PERMIT M;Y" U
FR VA'T'S ISPOSAL SYSTEM @ $'3�oc;
-'IF D LU
C01 N N F_C T ADD[�-TONAL IN D G.OR A—VIT RE7CCARD.?NSTR�14�;. X-VE
@ $3.00 iw-
WORK TO HOUSE CEWCR
VERFL6w sEkP7AGEPm DRAmiF_iE_LC_
FXTN.,CEFSFC,'OL,DRYWEI._.MANHOLE @ $5.00
AL LTFR�REPAIR OR ABANDON Tk6us9___ ____ -_ I HWY.OR ST.,&�DTN
SEWF DISPOSAL Sy,5TEM @ $3.99
ST�'TE—CRCJ.!�CHMENT
PERMIT NO.
I N D 1)STRIAE
WASTE APPRO V.AL
CHARGES
OWNER'S PERMIT
AUTHORIZATION TOTAL FEE v CONNECT ION CHARGE FEE
I HAVE AT THIS S DATA COT-47RACT WITH THE HEREIN NAMED CON- REIMBURSEMENT.FEE
TRACTOR TO
CONNECT THE DESCRIBED DESCRIBFEXISTING DWELLING
TO T H E PUBLIC SEWER. APPROVALS DATE JINSPECTOR'S SICNATURE
SIGNED TH15_____0AY
OWNER OR NEW HOUSE SEWER
OWNERS AGENT—___ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE 'THAT 1 HAVE READ 7HIS APPLICATION AND/OR DRA!NFIELD
AND $TATF THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
W17ALL COUNTY ORLNNANCLS AND STATF LAWS REGULATING
PLUMBING AND .EWERS, CESSPOOL DRIWELL
HEREBY CERTIFY THAT I AM. PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
AS REQUIRED BY i.05 ANGLES COUNTY AND STATE OF SEWAGE D'SPOSAL SYSTEM
ALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RES iCE IN, THE ABOVE DESCR�BED RES!'p4NTIAL.X.ROPFRTY,,'
ABANDON HOUSE SEWER
SIGNATURE Ti
_p,PLI-SEF CTANKS
BACK'i
OF SEE IT(S) El CESSPOOLS
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.0. CASH
13