HomeMy Public PortalAbout9611 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGNEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST ✓' ` ff
CROSS ST L... RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ]y
yMAIL
ADDRESS a �� '` y 4 USE ZONE OCCUPANCY BK MAP PG
CITY -,L c TELNO. I
CONTRACTOR
CO.IMP.NO.
ADDRESS
JOB.NO.
CITY TEL.NO, TRUNK PERMIT NO.
REGISTRATION NO. El COUNTY ROAD PERMIT NO.
'LEGAL '
DESCRIPTION LOT N0. ' x � STATE ENCROACHMENT
/ �`
"` PERMIT NO.
BLOCK ---- TRACT ��� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT< ANO.OF BLDGS.
,NOW ON LOT a CHARGES
USE OF
BUILDINGS � � .yy� ,r a .d CONNECTION CHARGE FEE
NO. ` DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO f
PRIVATE DISPOSAL SYSTEM 1.00 1
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING ` 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 1 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPrER LOWER
�I L I TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 1 00 --
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P BLIC SEWER
SIGNED THIS... DAY OF.. 14- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT �� .. BUILDING OR WORK
�y SEPTIC TANK,SEEP.PIT(S)
ADDRESS...... ZZs t _°_.__ :._ ..__. +?i :( AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPL1- 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLV�
OF PERMITTEE---------•---- -._.._...._................................___....__..__.
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