HomeMy Public PortalAbout9551 OLIVE ST_Sewer__ DEPARTBUMM OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND.SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS BUILDING
FOR APP,LICA T TO LOCALITYBUILDINIS
NEAREST
ADDRESS �� -GROSS ST.
LOCALITY DISTRICT NO. SER1A;C°Ne PERMIT NO.
NEAREST
� ���
CROSS ST.
Q REC�yV Ready for Inspection DA 1�U�91
OWNER �j/J- 8C.�"
MAIL ZACVOOCCUPANYADDRESBK M9 PO
CITY TELNO.ty
CONTRACTOR CO.IMP.NO. Z
ADDRESS Goy JOB.N0.
CITY � � TEL.1110.4 C f TRUNK PERMIT NO.
STATE
REGISTRATION N0, r �jP� ?j COUNTY ROAD PERMIT NO.
LEGALA STATE ENCROACHMENT
DESCRIPTION LOT NO.
/�� PERMIT
BLOCK TRACT � � INDUSTRIAL
h WASTE APPROVAL'
SIZE OF LOT�f�X `�y NOW ON LOT8. CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK • FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. I DATE �I BY
HOUSE SEWER CONNECTING TO s
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR /,�j CEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING �NO' I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE
Up LOWER
TYPE OF CQMYFO.T QPTY_CQ(1M
OWNERS PERMIT_ # 1 00 Cl)RB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE J 1—? - ,
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER .
SIGNED THIS.._.___.DAY O _ _� _19` NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT........... __ ���_Y_..... ..._ -._ BUILDING OR WORK L
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 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR.
REGULATING PLUMBING AND SEWERS,
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY DS ANGELES COUNTY ABANDON HOUSE-SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL P OPERTY. BACKFILLSEPTICTANKS�
e SEEP.PIT(S) CESSPOOLS
SIGNATURE �G
OFPERMITTEE. .. - -..-.-------- ---- - -.._.._.._,. . ..._.
76A642A 608 7/53