HomeMy Public PortalAbout9614 OLIVE ST_Sewer__ 1 •
rID PAIiITIE'NT OF comvTY ENGn�EEs 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 LOCALITYBUILDING '
NEAST
ADDRESS feg �C •r 04'i V ',CROSS ST.
LOCALITY � �� r a ' DISTRICT N0. SERIAL H0. PERMIT N0.
NEAREST . K- li„� A I'02 y S
CROSS ST. , N'�.'
RECEIVE q BBReady for Inspection /DATAOSSUED
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OWNER
ADDRESS gJr�B� 1:' USE ZONE` OCCUPANCY r BK AP Pe
CITY 2ENAAE
a -TEL.BO- ooe-/ I 'Oe
CONTRACTOR fl v r :CO.IMP.NO.
ADDRESS -�
JOB.N0.
CITY �ys,ehlj40�TEL.NO-d��47.jZ TRUNK PERMIT NO.
STATE
REGISTRATION N0. ; ROAD.PERMIT NO.
LEGAL .s a STATE ENCROACHMENT
DESCRIPTION LOT N0. ,PERMIT NO.
BLOCK TRACT urs INDUSTRIAL
WABTE APPROVAL.
SIZE OF LOTZO-X NOW ON LOT& CHARGES
USEOF
BUILDINGS CONNECTION CHARGE F
BUI
NO. DEscRipFriON 13F WORK FEE Is
HOUSE SEWER CONNECTING TOREIMBURSEMENT FEE
PUBLICSEWER @ $ 3.30 d RECEIPTNO. NkATii BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.60
CONNECT ADDITIONAL BLDO:OR // EXCEPTION REOORDED
WORK TO HOUSE SEWER 1.00 / NO- I DATE I BY
ALTER OR REPAIR'EXISTING. /!
_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 DRAI.NFIELD 2:00. STATION DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00- s Sr MANHOLE REFERE�1 E .rte
YPE OF CONNECTION LENGTH FROM/
M.L.TO P.L. (}
OWNERS. PERMIT S I 00
AUTHORIZATION~I TOTAL" FEE I D
I HAVE THIS DATE CONTRACTE tWiTH THE'HERE N NAMED
CONTRACTOR TO CONNECT THE O DESCRIBED EXISTING APPROVALS INSPECTO SIGNATURE DATE
DWELLING TO THE UBLIC BEWE
SIGNED THIS..._ .. DAY OF _ _
�, 'NEW HOUSE SEWER
OWNER OR •CONNECT ADDITIONAL
BUILDING OR WORK
OWNERSAGENT . ...... _ -- - SEPTIC TANK,BEEP.PIT(S)
p_ .._..__
ADDRESB,_.:. :Ld - ..c.:. - ..L�QL .��GG __-..__. AND/OR DRAINFIELD
I'HEREBY ACKNOWLEDGE THAT,1 HAVE READ THIS AP.PLI- CESSPOOL.[] DRYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR,
HEGULATING PLUMBI O D SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTI AT 1 AM P PERLY REGISTERED -
AND
LICENSED ` E BY NGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CA I NI HA i A THE LEGAL OWN- ABANDON HOUSESEWER
ER OF THE ABO C E A. OPE Y. BACKFILL SEPTIC TANKS
EEP.PIT(S)[] CESSPOOLS
SIGNATURE
OF PERMITTEE
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