HomeMy Public PortalAbout9546 OLIVE ST_Sewer__ 6A 642D -CE808 -10-71 APPLICATION FOP PERM I;IIIIIIl)
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING f��/y,��
ADDRESS / � 8 J.
H
g'.../ LOCALITY
NEAREST .e..� r
FOR APP LICA TO FILL IN cRDss sr ' % e (y�o / 6'1-1,,
LEGAL ,.. -T _-
DESCRIPTION LOT NO. OWNER
/+ MAIL —
BLOCK TRACT ` ! - ADDRESS
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL, NO,
USE OF
BUILDINGS DISTRICT NO. GROUP MAP ROCESSEO BY
0K PS
CONTRACTORy N
ADDRESS N> _ CONNECTIODA A
� •' �. t
CITY C `%'I� STATION DEPTH �'�
STATE > LIC UPPER
LICENSE E NO. /;.�,/y ,,�/ CLASS MANHOLE REFERENCE
—'. _+�- '�'i 'f 7« ,r L,i > ��(j LOWER
NO. -DESCRIPTION OF WORK FEE TYPE OF CXpN#teKION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB M.L.TO P.L. '
PUBLIC SEWER @ $7.00
P.C.NO.
SEPTIC TANK.SEEPAGE PIT OR _
PITS ANO/OR DRAINFIELD @ 510.00 CO.IMPNO. �yi -'' .108 NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. CL
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER -E.SEMENT RECORD.iNSTR.NO. DATE (J
WORK TO HOUSE SEWER $3.00
O ;FLOW SEEPAGE PIT,DRAINFIELD o
R,
TN.,C POO L.DRYWELL, @_$5.00 HWY.OR STWIDENING
Ylk LTE REP IR -R ABANDON HOUSE . . I—
WER O ISPOSAL SYSTEM $3,00 �h STATE ENCROACHMENT W
MANHOLE $7.00 PERMIT NO.
----- - INDUSTRIAL Z
WASTE APPROVAL
OWNERS PERMIT $ 31 00
AUTHORIZATION I TOTAL FEE I C--',6' CONNECTION CHARGE FEE CHARGES
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF —19—
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS-
OR WORK
SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -_ _ ---
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CESSPOOL ❑ DRYWELL ❑
LCERTIFY THAT i AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR } 9
S REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM .. _
TOR THA M THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
THE AB V DESCRIBED RESIDENTIAj- PROPERTY. ABANDON HOUSE SEWER�'SBACKFILL SEPTIC TANKS ❑TTEE SEEP.PIT(S) ,,�"�.CESS DOLS ❑
e VALIDATION CK. P M.O. CASH
470 T T -�sOI ~✓ U .. .
'oA 6420 - CFg°$ - "3 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEW GE SPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING .`� w
ADDRESS �"
LOCALITY
NEA REST
FOR APPLICANT TO FILL IN GRD55 ST.
LEGAL - j <5
DESCRIPTION LOT NO. OWNER V ;
.. " MAIL �-"q
BLOCK TRACT " it.- :y ,) (� ADDRE55'"-/ �-
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY i (:TEL. NO.
USE OF ' F _
BUILDINGS .��(_ J4......-- DISTRICT NO. GROUPMAP P E55-ED BY
B K PS
CONTRACTOR
ADDRESS— � c i` � _—^�— COPtIVECTIO I DATA __ Y
- - STATION } .,DEPTH q
CITY TEL. NO. 7
UPPER
STATE LIC MANHOLE REFERS C q,j(,.y^'l• _
LICENSE NO;, GLASS - ,. LOWER
ND. DESCRIPTION OF WORK FEE TYPE OF CONNECTi Vk iG i FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L.� ''A.L.YO P.L.
PUBLIC SEWER $7.00
SEPTIC TANK.SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIEL.D ti0.00 CO.IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM 53.00
CONNECT ADDITEONAL BLDG.OR AFFIDAVIT WAIVES EASEMERT RECORD.INSTR.NO. DATE
WORK TO HOUSESEWER $3.00 �� C:)
OVERFLOW SEEPAGE PIT.DRAINFIELD � _ l
EXTN..CESSPOOL.DRYWELL. $5.00 L7
--
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING,y
SEWER OR DISPOSAL SYSTEM Q $3.00 C.�d-� STATE ENC ROACH M£NT �
MANHOLE s_ 0 $7.00 PERMIT NO. _ t
'— --'
INDUSTRIAL LV
4
WASTE APPROVAL C/J
OWNER'S PERMIT $ a 00 CHARGES Z
AUTHORIZATION TOD CONNECTION CHARGE FEE
TAL FEE —
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE 6E50ED EXISTING DWELLING '- APPROVALS 70 THE PUBLIC 5 ER DATE INSPECTOR'S SIGNATURE
SIGNED THIS _e'DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENT -- -'-'-' --
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS_ '" &✓' l�I �" _ f `.a-
STANK,SEEP,PITS)
i HEREBY ACKNOWLEDGE THAT I HAVE REAP THIS APPLICATION AND/OR
OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING n
PLU MI3ING AND SEWERS. CESSPOOL ❑ DRYWELL
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS. ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL 5YSTEM
CALIFORNIA OR THAT I AM 'THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
I.
SIGNATURE BACKFiLL SEPTIC TANKS ❑
6F PF_RMTTTEESEEP.PIT(5I ❑ .CESSPOOLS ❑
VALIDATION CK• M.G. CASH