HomeMy Public PortalAbout9566 OLIVE ST_Sewer__ DEPAILTYLENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY _ PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOBUILDINGX. COUNTY ENGINEER I ADDRESS Q
FOR APPLICANT TO FILL IN LOCALITY � /�+ --
ST
ADDRESS .� �� CROILD SS ST. G. �[/.
LOCALITY DISTRICT. SERIAL NO. nPPEERMIT N0. c
NEAREST A S
a
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL -
ADDRESS US Z0,E OCCUPANCY BK MAP PG
CITY TEL.NO. ( C:•�, .�a� l J`f
CONTRACTOR O'�� n.+�a ew^ f��f, Go.IMP.NO.
��
ADDRESSLP JOB N0.
CITY P1 TEL.N f� TRUNK PERMIT NO.
s+ STATE 7t<
�'�
REGISTRAT N N0. �,��/',���® CtO�UNTY ROAD PERMIT N0. ==5__/
LEGAL t S'B /rjr f A IHS! --
DESCRIPTION - LOT N0. S STATE ENCROACHMENT
R PERMIT NO.
BLOCK TRACT' r ��fiG! '� INDUSTRIAL
WASTE APPROVAL
S.
SIZE OF LOT ���A /J�� NOW ON LOTS / CHARGES
USE NO-OF
BUILDINGS pj., . S CONNECTIO akHARGE FEE
NO. DESCRIPTION OF W K FEE
REIMBURSEMENT FEE
OUSE SEWER CONNECTING TOf
PUBLICSEWER @ $ 3.50 Jr"y
RECEIPT NO. ` I DAT I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR �,EXOEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
NO' I DATED
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR c�
PITS AND/OR DRAINFIELD 2.00 STATION - -gam DEPTH
CESSPOSPECIAL
7'�/5 d PP�ER� -
SPECIAL CONDITIONS ONLY 2.00 � � MAN ERENCE
TYPE OF CONNEC 1 LENGTH FROM
OWNERS PERMIT ; 1 00 Y. CURB P.L. M.L.TO P.L. l �
AUTHORIZATION TOTAL FEE 5 '
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS 148 ECT R'SSIGNATUjlE' DAYE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.._I_ MAY OF_:'�t��_..._ 19— NEW HOUSE SEWER
OWNER OR /r CONNECT ADDITIONAL 01/
OWNERS AGENT.... -' BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S) /
ADDRESS..._.:_......_....----••---....---•--.._.._......_.-------._......_._.....�... AND/OR-DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-• CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS, ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY, ABANDON HOUSE SEWER i!
AND STATE OF CALIFORNIA OR'THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED IDENTIAL PROPERTY. BACKFILL SEPT C TANKS by
SEEP.PIT.( a[c-CESSPM0 CR f
SIO NATURE C i
OF PERMITTEE..._.
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