HomeMy Public PortalAbout9651 OLIVE ST_Sewer__ p -
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75Afi CL642D.52 APPLICATION FOR PERMIT`
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEARE
JOAN A. LAMBIIE, County Engineer
WILLIAM A. JENSEN, Supt of Building
__-7
—.FOR APPLICANT TO FILL IN
---- ---- - - -
DESCRIPTION LOT
OWNS
MAIL
p
_BL CK TRACT _._� ADD RFSS�.NOOF BLD 5.
4 -
SIZE OF LOT NOW ON LOT' CITY �-' �. TEL. NO. ^ 2.
USE OF
BUILDINGS DISTRICT NO.. GROCIP MAP FROCESSED BY
CONTRA FCR
_ PG �✓
#J
ADDRESS CONNECTION DATA
STATION DEPTH
CITY 'TEG.. NO.
❑ STATE MANHOLE REFERENCE
r LO
REGISTRATION NO COUNTY❑. tAWLR-
NO. DE.SCRI�7'IOfS OF WORK FEE TYPE OF CONNECTION LENGTH FROM
..._ __ _ _._ � _.-_. g
rtOUSE SEo-ER CONNECTING TO ' Y CURB P L. M.L.TO P L.
PUBLIC SEWER @' $S.00
- P C NO.
SEPTIC TANK 'EEPAC E PIT OR --_ -� --- --- k,
-
PITS AND.'OR DRA N IELD $10.00 CO. IMP. NO. JOB NO,
HOUSE SEW7R CONNECTING TO
i TRUNK PERMIT NO. ROAD PERMIT NO,
FR VATE DISPOSAL SYSTEM @ $3.09 i
' (.WORK
1 ADDITIONAL BLDG OR h FiDAV1T j wALYER EASEMENT EkT i RECOTiD iNSTP WO.� DP.TE'
i ti
_. WORKTO tic UuE SEWER @ $.3.00�-]��
OVERFLOW SEEPAGE P T.DRAIN FICLU
I EXTN.CESS POCL.O RY WELL.MANHOLE I� $5 00
"-
ALTER - ,„,HO.�SE- -- 3 HWY.OR S7 WIDENING
-'� "
_ SEJJERa-SYS TF C8'P S°3.00 J' Il _,. -
__. STATE ENi.ROACH MEN7' rc.
PERMIT NO.
INDUSTRIAL
i.
WA-TE APP OVAL
y` Cq?�V41NEF/R+a� 7�� PERMIT 2 00 - ---- �--, `�-' ''�� ' --1--, -
AUTHORIZATION TOTAL FEE - i COhINECT810NC ARGF_.�EE `
I HAVE AT THIS DATE A CONTRACT WITH THE.HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO ..ONNECT THE ASOVE DESCRiBED EXISTING DWELLING ------ ---- ------ - -- - 4-- ---
/ �e T—,
TO THE f--„SEWy:H ..� ,,,,+ A�PRO YALrJ DATE INSPECTOR sSIGNAITURE
S!GNE6 T'HiS fd DAY C1P 9 _ _ - - ---- - ---I- _"_-- - ”----
OWNER 6,R ,yy � �p �A`,i�3- _ NEW HOUS£SEWER
OWNC iS A [J' � _ CONNECT ADD.iT10NAL.___"__-_�
BUIL
ING
R WORK
._ SEPTpC TA1^lOK SEEP PIT(S)
IHAT I HAVE READ THIS AP;Z-ATION
I i'PE RSB ACKI.OW:.EDGE AND/O o RAINFfELD
AND 57'ATE THAT THE ABOVE CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND FWERS. CESSPOOL [-I DRYWEL.L. ❑ �' ,., s
I
HERESY '.^ECT F'Y THAT' 1 AMPROPERLY REGISTERED AND/'OR ALTER,REF'AIR,.SEW ER O DR
LICENSE15"AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SWAGE DISPOSAL SYSTEM
GALif'ORNfA OR THAT ! AM THF LEGAL OWNS O.', AND INTEND TO �
R' DISCONNECT PLUG AND '
RESIDE IN, 'CMF AB6'VE DESCRIBED RE%IDENPiAL;PROPERTY. ABANDON HOUSE SEWER
d
SIGNATURE' .,f r r'. - -� "� PArKFIL L.
OF R`t7R 156 f5`T`E' SEPTIC TANKS_ �5ZFP,PITfS) ❑ CESSPOOLS
VALIDATIOI3 ROBERT A. D
t SUPERVISING MECH ENGINEER
CK., M.O. CASH
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78AS42Q
seas i1•ss APPLICATION FOR. PERMIT 1
�
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depcmtment of County Engineer
County of Los Angelos f,DDRESSdl` 6
!_
JOHr4 A. AMBLE, COUNTY ENCINEERP , - -- --
J CASSATT D. GRIFFIN, SUPT 0uLOCALITY
UILDING
FOR APPLICANT TO FILL IN NEAREST
CROSS ST -a•.G. `C i.,t ._ _._ 4 t'e. F
LEGAL
DESCRIPTION LOT NO, OWNED
AlL
BLOCK TRACT DDRESS
- -- rhe. a,'•�--NO. OF BLDGS. °-�--- - y
CITY 5 TEL, NO.
slzE o LDr • NOW ON Lor ,� -� -- .--
USE OF — -- ---
BUILD Nr & y G3- ✓ z;..,✓ DISTRICT NO, a- GROUP - MAP
BK PIS
CONTRACTOR_ --q r SI
ADDRESSl �� ` ' CONN ION DATA
-_ - - -- ---- -----
r ✓ k �, S'TA7JON DEPTH
CITY — ° -_� TEL. N4 s'�-�. ro,,/ z' .�_....__ MANHOLE REF ENCE UPPER
1 e �2r STATE . i, LOWER
REGISTRATION N0. .. '1 a�; `,i'. - — ---
�— -- _ > '❑ COUNTY
No. DESCRIPTION OF WORK FEE �M
-- --- .-_ --._-- -. TYP OF
�- MOUSE SEWER CONNECTING TO NEC'TIO LE
N H FRO
- UBLIC SEWER @ $-3-,50 -Y CU P L_.F L,fi0 P L.!_ -----
11t--- a. -- - - -'`-- -
SEPY f;TANK SEEPAGE PIT.OR
PITS AND/OR AND OR DtAINFiELD Cr< ------.
OVERFLOP sf-F.ACE FIT DRAINFIEL.D I� P C N0.
EXIN.,CESSP�OL,DPYWLLL.,MANHOLE Q $2.00 -CO_. IFkP_NO.----
HOUSE SEWE'.CONNECTING TC
PRIVATE DISPOSAL Sv EM (I $1.00 TRUNK FE R tl7 N0. t `� ROAD PERMIT NO.
rCONNECT HOUSEADDITIONALBLDG OR STATE E14CROAC ENT. `: --- - -- -- --
WORK To HOUSE SEWER GP $LDO1 PERMIT NO
i \ TER,REPA R OR ABANDON HOUSE INDUSTRIk - - -
SEWER OR DISPOSAL S S7 F.M (u' $1.00 __ WASTE AP
r v
Cr'tOM CHARGE FEE --
OWNEXS PERMIT $ I 00 REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEES
I HAVE I THIS D,�JC A CONTRACTWITH THE HEREIN CON.
APPROVALS DATE---I�
iNSP.E_CT
OR'S51G_.N_A_T-:U_RF
TRACTOR CONNECTTHE ABOVE DESCRIBED EXISTING DWELLiNG
VGTHE PLq_ aUNE NEW HOUSE SEWI R _
SIGNED Tkil _ DAY OF � �. ��.v> ;' 19 �� -- -�- --- -
t CONNECT ADDITIONAL
OWNER OR ✓I / BUILDING OR WDRK - -} -
OWNERS AGENT '� .u ..—.S,..t_,..—.�.'�L?r_ -�`•'---..� ._.— �- ---- --- �--- — — ---
... SEPTIC TANK,SEEP,PIT(S)
,D DR ESS dY.,`�.-._-;%e f t- '� AND/OP.QRAfNFfLLll
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL`+CATiON CESSPOOLC DRYWELL[)
AND STATE THAT T14E ABOVE IS CORRECT AND AGREE 70 COMPLY --- - -- -- -- --__- -.__—__
WITH ILL COUNT}' ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUNIBING AND S WIERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY C R7 FY THAT .P AM P GPERLY REGLS:EP,ED AND/CR —DISCOhNECC PLUG AND� -------- --
LICENSED AS RFQ.JR,ED PY LOS At GELESj COUNTY AND STATE OF
CALIFORNIA OR 1AAT T',AM THE LEGAIr OWjNtR, OF THE ABANDON' HOUSE SEWER
.ABOVE --- - SEWER ----
DESCRIBED RE.SIDENTIA�,,MOPERTY. /`. BACKFILL SEPTIC TANKS LJ
SIGNATURE SEEP.-PIT tS:. DD CESSPOOLS
Of PERMiTTE, !" --- ------- —- i I -_
iOHN A. LAMBiE,Cop;& ENc INFER ALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
GK, Si. O ASR
gu is fa
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