HomeMy Public PortalAbout9645 OLIVE ST_Sewer__ TGA -663 3•$s
EAPPLICATION FOR PERMIT
S& •66
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS 9 � [j��'�
CASSATT D.GRIFFIN, SUPT of BUILDING LOCALITY �q
FOR APPLICANT TO FILL IN NEAREST
LEGAL -- -
DESCRIPTION LOT OWNER
-
k. :b S
BLOCK TP1GT MAILyiew AcreADDRESS 94IX* S._t.___
NOOF BLDGS.
SZOFLOF NO.W ON LOT CITY FEL. NO. A-.t_
696J9
USE
9
USE OF
U1S7ftIC7 N0, GROUP MAP
t�2i11fGy��F CST+ v lttcT I BK PG
CONTRACTOR ..> s ._.lddid3N u�J. `164.12 CON
ADDRESS 1=6 'Wanda Ave CONNECTION DATA -
CITY 1'EL. NO. STATION i1: K-` DEPTH
.- '.. --STATE MANHOLE FrEFERENCE
REGISTRATIONN0. 1i .�' ❑ COUNTY
NO. DESCRIPTION OF WORK FFE
---- --'— _ TYPE OF CONNECTION LENGTH FROM I
HOUSES v.ER CONNECTING TO - } Y, CLi?B P.L. M.L^TO P L.
PUBLIC EWER @ $ 3.30
_ .—_ .__ _ _. ._.z._—
HOUSE SEWER CONNECTING TO t
PRIVATE DISPOSAL SYSTEM 1.601 -- ---- -- --- -_—
CONNECT ADDITIONAL BLDG. OR P C. NO. -
WORK TO HOUSE SEWER _ 1,60 -- CO,_]MP. NO. OB NO._,_--�-- --
1
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM _ 1.00` TRUNK PERMIT NO, ROAD PERMIT NO.
DISCONNECT AND ABAFT:TON SEWER i STATE ENCROACHMENT
AICD OR DISPOSAL SYSTEM 1.00 i
SEPTI::1 N?, SEEPAGE: FIT OR --'-- -----(�—� PERMIT NO. _ - .---.�--�--�— �-
�� PITS AN OR_DRAINIFIEL_D_ 2.OD � INDUSTRIAL
�I CESSPOOL-DRYWLLL — WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00�C�^
---- -- CHARGES
!� -��.'�—
CONNECTION CHARGE FEE
Ov R's - PERMIT_ v f—i�_0Q _�— ----- --__—
AUTHORIZATION TOTAL FEE _I REIMBURSEMENT FEE
I HAVE "IHIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBL C SEWER ------ '---_
NEW HOUSE SEWER
SIGNED THIS— DAY CF � �
CONNECT ADDITIONAL -- .
OWNER OROWNERS 1.I .. BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
AND/OR DRAINFIELD
IO ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL DI
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH AL1. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING A`ND SEWERS. SEWAGE DISPOSAL EOR R
O
R ALTER,REPAIR. SEWER _
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND�v
EM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFCRNIA OR THAT I Ati THE LEGAL.--OWNER OF THE ABOVE AF3ANDON HOUSE SEV"ER _
DESCRIBED RESIDENTIAL PROs Imry,
,y ✓ BACKFILL SEPTIC TANKS 0
SEEP.PIT(S) [] _CESSPOOLS❑ _
SIGNATURE //y i� i :Z.
OF PERMITTEE - .....�,p._
WILLIAM J.F'OX.COUNTY ENGINEER VALIDATION R.A.WOOD.CHIEF PLBG. INSPECTOR
..r
;IAV-663 3.55 FOR APPLICATION OR PIER.MIT ... 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING gy �''
WIM.J.FOX, COUNTY ENGINEER -ADDRESS .' 01iy i' S°t�
CASSATT D.GRIFFIN, SUPT OF:BUILDING LOCALITY
FOR APPLICANT TO 'FILL IN NEAREST
—.CROSS ST
LEGAL �/�rr y� �y
DESCRIPTION LOT NO 'T� .L ! 53:' OWNER-m
BLOCK TRACT g AB"� MAIL
M''0' �:0W - ADDRESS
�9iI NO.OF BLDGS. _.— E?�I�— -.�.�_.�._.__.��—__..�
SEZ,£OF LOT _LI NOW ON LOT• -_ CITY TEL.NO.
USE OF —"
BUILDINGS ___ r __—_T_ _ _ DISTRICT NO,. GROUP MAP
�+ C+� ry y. BK PG
CONTRACTOR &J, CMN &M&r t'o ti I.
ADDRESs " CONNECTION DATA
—- --
CITY _ y _- -.��.._TEL. NO:ro. 87718 STATION :� { Q._�. DEPTH
��y� ESTATE MANHOLE REFERENCE
__ UPPER_
REGISTRATION h0' _'UACd — C_COUNTY ----- ------__��-. _-.--- _.__
_NO. DESCRIPTION OF WORK FEE
HOUSE 5F t£R CONNECTING TO I r TYPE OF CON'NEC,ION L€NGIH FROM
- 50YC
5 , � URD _ P L_._- _M1._TO P. _ _
—a-PUBLIC WER t% 3 3.BU - L.-
- -�
HOUSES SEWER CONNECT ING TO
i PRIVATE DISPOSAL SYSTEM 1.00 I --- --- ---- - --
�CON"tECT ADDITIONAL BLDG. OR I P C NO
_WOPK TO HOUSE SEWER _ 1.00
ALTER 0R--REPAIR EXISTING
S,F 1,1_El2 0 1115_P0_11L SYSTEM 1.00 I STRUNK P'"RMIT NQ. ,._.M ROADPEPM,T NO. - I
DI CONNLCT AND ABANDON SEWER
-- s
ANui OR DISPOSAL SYSTEM 1,00 STATE ENCROACHMENT
PERM 7 NO
---
—� ..—
SEPTIC TANK,-SECPAGc Pl'I'1T OR----^ — 1 -�---- -
PITS AND/OR DRAIPFIELD 2.00�___T! INDUSTRIAL
--.' - WASTE APPROVAL.
CFS POOL DRYWFLL --
�_�_
SPECIAL CONDITIONS ONLY Y 2100
CHARGES
i --
--" CONNECTION CHARGE FEE
OWNER'S PERMIT S � 1 00 -...- --'- —-'--- - --
AUTHORIZATION TOTAL FEE , �e � 50 REIMBURSEMENT FSE
1 :WAVE THIS DATE CONTRACTED WITH THE HEREIN NAIMEU CON
TRACTOR TO CONNECT THE. ABOVE DESCRIBED EXG ING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER;
SIGNED THIS DAY OF 19 NEW HOUSE SEWER
'NNER OR .r-j•F 4 i.-,'I"' 7 � _CONNECT ADDITIONAL
OI }!t
J ?;,- 7 1 �" `"� !¢ 1 BUILDING OR WORK �..-----`-�-
OV?HERS AGENT--J.-.Y ---,r`--` 3 - -- - .._--' - --• - �..____.._ -
SEPTIC TANK,SEEP, PITS)
ADDFES5e __ '. -_.— ------_-- _ AND/OR DRAINFiE1.D
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL[-j
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SELVAGE.DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM-'PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS AdGELES COUNTY-A*D STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM�THE LECALi,DVER OF THE ABOVE _ ABANDON HOUSE SEWER
DESCRIBED RESIDENTFAL-I1ROP4,RTY. f"� BACKFILL SEPTIC TANKS E;
SEEP.PIT(S) E! CESSPOOLS 0
SIGNATURE
OF PERMIT,Ez—
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
z.,r 7 9 4 4.5 1� IIT