HomeMy Public PortalAbout9628 OLIVE ST_Sewer__ 5A
Iz.�.a E-02b APPLICATION FOR PERMIT1
�
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
Countyof Los An -le BUILDING Ad
VECVI,J. FOX. COUNTY ENGINEER
ADDRESSEl
CASSATT 1D. GRIFFIN,SUP'T OF BUILDlPiG 4LOCALie'Y FOR AFFLICAN'T TO FILL IN NEAREST .CROSS ST. Ca.'iv' ,s%LEGALyy :_DESCRIPTION LOT NO_ -`- % OWNER L ai-:i r ;L. U vBLOCK TRACT + aV„'- 7�-,-, .yMAIL ,.-
ADDRESs ,.�'–N0. OF BLDGS. j SIZE OF LOTS-{,. 1 �:!` N_OWON TT GiTY : "S TEL '`'�' `.
USE OF
BUILDINGS ;"' y 1 e DISTRIC ..NO, GROUP i MAP
V
CONTRACTORM
s
ADDRESS • - CONNECTION DATA
CITYTEL. 06 STATION DEPTH
,.
[] .STATE MANHOLE REFERENCE
REGISTRATION NO. - - ❑ COUNTY - UPPER r WER-_
IYFE OF CONNECTION LENGTH FROM
ND. I DESCRIPTION OF WORK FEEL, M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC
S FAI ER $ 3.50
HOUSE SEWER CONNECTING TO
I PRIVATE_DISPOSAL SYSTEM_ 1.00_ ..-
1
CONNECT ADDITIONAL BLDG. OR
—.�.!
WORK TO HOUSE SEWER 1.00 I—^_ CO. IM.P. NO. d„r � �, JOB. NO. -
ALT R OP REPAIR EXISTING
I.SEWER OR D.S'POSAL SYSTEM 1.00 I T.-1JNK PERMIT NO 5'i ice. �;=----ROAD PERMIT NO.
DISCQNN Cf AND ABANDON SEWER IST1kTtif".tY't`ft177S'I:'17'"6?£'!d`F-'Y
ANO OR i5° .
C.SAL SYS E-14 1.00 I ,{ r1
^_—_ —.�_._ •PE #14+-NQ h' .FI d f. s ,,r y •.9A- ( dc: 2 ,
StFa IC T,NK,SEEPAGE PIT OR
F i 2.00 I. INDUSTRIAL
(
CESS'r CCt_- DR`/WELL —I WASTE APPROVAL
IAL CONDITIONS ONLY 2.00 i
ICHARGES
I— CONNECTION CHARGE FEE
OWNER'S P ERMIT i d Go
A ---
f[ �f ft ----- 1----
UTHORIZATIOi'i1�YTOTAL FEE ��. -> RF_�IMBURSEMENT FEE.,
I 14AVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CDN- i1
TRACTOR TO CONNECT THE ABOVE DE;CRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC g.WER -
r NEW HOUSE SEWER
SIGNED THIS. _ DAY OF
OWNER DR { {{ CONNECT ADDITIONAL
OWNERS AC ENT '�_,. 8 d .!'I-._z.o�_�r BUILDING OR WOR_K.___-- - - -
�.��'
SEPTIC TANK. SEEP, PIT(S)
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL C3 DRYWELL❑
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS'
SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR --'-`�–
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND .STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT. I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY, -- --- BACKFILL SEPTIC TANKS[]
SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE __..
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY
DEPUTY DEPUTY 0
BY BY '
DEPUTY r.'°A'e. DEPUTY.
E- °. APPLICATION FOR PERMIT :. Z
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS a sss.F
WM.J. FOSC, COUNTY ENGINEER — .----. .�--------
CASSATT 0.GRIFFIN, SUPT OF SUILOINQ
LOCALITY
NEARESTI9� x-
FOIt APPLICANT TO FELL IN _cROss ST. I
LEGAL — —
DESCRIPTION_ _LOT NO. - OWNER ,y _
BLOCK-- YTRACT y .+ t Y;, �: w WMAIL —. --
-- ADDRESS _��.
40. OF BLDGS.
ON LOT
E_OF I.OT „,
"F� 4er 'N04V E CITY .� TEL.NO.
USE OF :,
_B.UtLDiNG5 DISTRICT NO. GROUP
y� -,-gyp[ ..-- - BK MAP PG
_CONTRACTOR LLQ„/ + _ � I y'". .
r
� t
ADDREss `� CONNECTION DATA
CITY 4 ;Ir-TEL. NO. - STATION DEPTH
fI ❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. I -ra.,f r .�� _
No_' DESCRIPTION OF WORK FEE ------
TYPE OF COisIiECTION LENGTH FROM
hOJSE SEWER CON14ECTING TO Y, CLRB P.L. M.L. TO P.L.
_ PU£LIC""E'_
L7!£R _ 0 $ 55.50 { .___ -- ----- —�--- -- -
HOUSE SEIYER CONNECTING TO E ��
_ PRIVATE DISPOSAL SYSTEM___ 1.0_0_ I�__ _ -- ------------ ----
LCONNECT ADDITIONAL BLDG. OR - 1 P C NO.
� I-WORK TO HOUSE S.VIER L00 J° CO, IMP. N0. JOB NO. .
ALTER OR REPAIR EXISTING -�------
5E1"ER OR DISPOSAL SYSTEM 1.00 l'RUNK PERMIT NO, ROAD PERMIT NO.
—`�
j DISCONNECT AND ABANDON SEWER - - STATE ENCROACHMENT--y—_--�---- -----�--- -----
I AND. OR DISPOSAL SYSTEM_ 1..00
-- CHME'N7
PERMIT NO _
—� SEPTIC TANK. SEEPAGE PIT OR k ------INDUSTRIAL
PI(S AND(OR DRAINFIEln ,--_-__ .QO �f
CESSPOOL- DRYWELL
-'—� :TASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00
_-.-�--- —__---- -- ----t� - � CHARGES
PERMIT - i--- CONNECTION CHARGE FEE
OVMEWSAUTHORIZATION TOTAL FEE �— REIMBURSEMENT FEE
f x�
I HAVE THIS DATE CONTRACTED 1 1TH THE HEREIN NAMED CGN- try yep
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'SSIGNATURE
TO THE PUBLIC SEINER ""� -- ---'..— -- --- —
SIGNED 1 HIS __ NY OF p q NEW HOUSE SEWER
OWNER OR CONNECTADDITIONA.L
OWNER'S AGE, _BUILUI.NG OR WORK
✓'' " �. r SEPTIC TANK, SEEP. PIT(S)
ADORES= ,:., ._._ AND✓OR DRAI_M1_FIELD___
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .CESSPOOL(] DRYWELL'I]
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/GR -----
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF T ABOVE ABANDON HOUSES_EWEP. _
DESCRIBED RESIDENTIAL P ERTY. _ BACKFILL SEPTIC TANKS[;
SEEP.PITS} (r] CESSPOOLS
SIGNATURE
- _ _OF PERMITTEE
WILLIAM J. .COUNTY ENGINEER VALIDATION R. A.WOOD,CHIEF PLSG. INSPECTOR