HomeMy Public PortalAbout9522 OLIVE ST_Sewer__ CE608 10-62
76A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
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JOHN A. LAMBIE, County Engineer E7
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NEA.CROS
FOR APP41CANT TO FILL IN SS T
All
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LOT.NO. owNER
e
MAIL
BLO�KI"C T
NO. OF BL DGS.
SIZE OF LOT NOW ON LOT ciry TEL. NO.
USE OF
DISTRICTNO. GROUP MAPCEsSED"Y
P
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ADDR sy
ONNECTION DATA
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MANHOLE REFERENCE
REGISTRATION NOOUNTYz LOWER
N.o. C�ESCRIPTION OF WORK .`'EEEYPF'OF;:ONNECTLON LENGTH FROM
Y. P L. pj
�!zwER $5 oo ------------
' PUBL—
SEPTIC TANK,SEEPAGE.PIT OR P.c.No.
FITS AND/OR DRAINMELD @ po.00 CO.I m� No POB No.
TRUNK PERM IT ROAD PERMiT`-- -Z
HOUSE SEWER CONNFCliNG TO NO.
PRIVATE DISPO AL SYSTEM @ ss.00 Q
iiico—c7-i4i� N 0.- -&-ATE- U
CONN cT A[�DITIONA'-BLDG.OR I
W�RKETO HOUSE SEWER R LU
CL
OVERFLOW$EIEPAGE PM EIRAVNF�MLD (4
F.XTN.,CE5SPOOL,DRYWELL,MANHOLE @ $s,00 z
AL ER.REPAIR OR ABAqooN HOUSE HWY.OR ST.VIPPENING
5 E E R^P P 0 5 A 1-SYSTEM @ A -- ------STTEENCROIcHMEN, —
PERMIT
L
WASTE APPROVAL._`
CHARGES
EMIT $ 21 00
OWN] CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAV AT THIS DATE CONTRACT WITH THE HEREIN NAMED CON' REIMBURSEMENT FEE
'. A
TRACIO i? TO CONNECT THE ABOVE OESCRIBFr EXISTING DWELIFNG
THE
TO , P US L Ic SEWER. APPROVALS DATE INSPECTOR'S SIGNAI: RE
SIGNED THIS-,_____DAY --- ----SIGN
.-- ------
SSSS— SSSS--
OWNER OR NEW HOUSE SEWER
OWNERS AGENT---
CONNEQT ADDITIONAL
ADDRESS BUH-DING OR WORK
SEFT7C TANK,SEEP,PIT(S)
IHERFBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATiON AND/OR DRAINFIELD
AND
STATE THAT THE ABOVE ISCO CORRECT AND AGREE TO COMPLY
WITHCO_;ALI. N-1V ORDINANCES
AND STATE LAWS REGULATING
PLU Mn i.. Al. SEWERS.
E Rs, CESSPOQL, 0 DRYWELL
HEREBY CERTIFY THAT I AM PROPFRLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
I.7
E L
C NS E D AS REQUIRED BY QS ANGLES COUNTY AND STATE GF SEWAGE D'SPOSAL SYSTEM
'CAL I OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
E U5
RrSi IN, THE nROPERTY.,, E SEWER
7 E E- U:%ENTIAL ,DISCOPdNF. PL{ AND
RE.- ABANDON H,
SIGNATURE
QE PERMHTT E< t BACKE'iLL SEPTIC TANKS
SEEP,YCTfS) D CESSPOOLS
VALIDATION ROBERT A. WOOD
CK., m.o. CASH SUPERVISING MECHANICAL ENGINEER
3 7.1a
A642D �x
I
Y6A842D APPL C+�TION FOR PEPERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DIS
i'OSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAh3BIE, County Engineer
WILLIAM A. JEN EN. Supt of BuildingOCALITY
NEAREST
FOR APPLICANT TO FILL IN `ROSS 5f --
I. � 'J'v�
LOT N OWNER
DESrPIPTION _' — - - __-
-- -- �� MAIL
SLO.CK ,RAIT ��+ ,...> ADvR.ESS
NOr OF BLDGS,
A-.11
_A
SIZE OF LOT P40W ON LOT CITY TTEL. NO.
USE Or
BU;LD!NGS DISTRICT P40. GROUP MAP PROCESSED BY
BK PG
CONTRA 7ORe` °'° ,, a" ,,� s „v✓ t
— - - X_ � --
ADDRESS ,-,� e,� -- - _-, `CONNECTION IATA
--
E _ — ' t s A:;o� SEP
CITY �} � x 7'EL NO. S ' y „>� ',:.a
REGISTRATION NO. yP' �'9�-t %� OUFiTY MANHOLE REFEF'LNCE
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_ Li W R
. lI FtiPTIF v"JO_R
NoGESCK FEE -- -- — " LENGTH - y
TYPE OF CON', CTtON FROM
C3
HOUSE SEWER CON NEC'r'ING TO .- Y. C�.._ ? Y L._ __ M L TO P.L__-. _ _.- O
PUBLIC SEWER C� E'.(-FO_ ~—Y
SEPTIC TANK.SEEPAGE PIT 012 I
__i PITS.AI'D/OR PRAINFIELD ( 3.=0.00 CO.}MP N0- _— JOB NC7
7 OUSC 5 EwE aCONNECT NG 0
I PC'ROINU NTEE.. G 11--.O-NAL NLD:.OR- -----'-- - --_ YR,NK PERM--17--N9
. r ROAD PERMIT'ON. L
DISPOSAL YSOEM •
DATEEn
WORK T- —
_
HOUSE USE y EWER @ 43.0 Uj
EX
r'R,'-ESS OOL,D-t i IT,DRAIN FIL`"LD HWY.OR 4 xYigEN
EX TN.rE POOL,E.R WF"'Z,.L.,MANtx _ 4S
OLE $5-00 `
..._ ____ IN
--AL-TER,R PA R ORLSYSTEM ABANDON HOUSE——
W -3R DI.�PO5 L SYSTEMENCROACHMENT
I
x.3.00 ACkM 27
- T —_ ENc RO -
° PERMIT NO -.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVVNER'S PERMIT _--
- ------
CONNECTiON CHARGE PEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE: A CONT'RAC'T WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE. ABOVE DESCRIBED EXISTIt'iG DWELLING -----
DATE INSPEC
APPRO YAL� -- ----- -- --- --
TO THE PUBLIC SEWER. --� T "COR SSiC;NATURE
SIGNED THIS,__—,DAY
OWNER OR NEW HOUSE SEWER
OWN ER5 AGENT,__.--_, _nWHOVSE SEWER
OW
NERS AGENT--------------
CONNECT ADC3i71C7NALADDRESS
BUILDING OR WORK !
- - SEPTIC RANK.SEEP,FIEL
N1
NEREBY ACKNOWLEDGE THAT f HAVE READ THIS APPLICATION AND/OR DRAINFIELD
ANL^ STATE: THAT THE ABOVE: IS CORRECT AND AGREE TO COMPLY
W'iTH A:' COUNTY ORDINANCES AND STATE LAWS REGULATING 4
PLUMBING AcaL -'_Wr o. CESSPOOL
LI 0 RY'W EL L
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,R-PA.!R,SEWER Oil
LICFNS'ED AS REQUIREl`, BY LOS ANGLES COUNTY AND STATE OF 5EWAGE DISP=OSAL SYSTEM � I
Ai.;F E3RNiA OR THAT I AM 'r'NE :..EGhL OW MFF( OF" :AND INTEND TO
RESiD 1N, THE ABOVE DESCRIBED RESIDEPTIAL PROPERTY DfSCONN ECT PLUG AND
d
ABANDON HOLISL SEWrR
OF PERMITTEE�yLl SEPTIC TANTS
SEEP,PIT(3 73 CESSPOOLS
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
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