HomeMy Public PortalAbout9663 OLIVE ST_Sewer__ DEP"nOF COUNTY ENGngMM 1
A>Et'1' ' SEWER—SEWAGE, DISPOSAL
BIVISION OF .BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANPPL
G=S _ PPL '
WILLIAM J. FOX, COUNTY ENGINEER ;;I ADD REBUILDING
C'J' ✓•� �.J
FOR ALP CANT TO-F IN - LOCALITY"UILDIN NEAREST
ADDRESS CROSS ST. G •r
LOCALITY DISTRICT NO. A SERIAL NO. PERMIT NO, c
NEAREST �� �`�
CROSS ST. RECEIVE B!Y Ready for lnspeetion -DAT ISSUED
OWNER F \ �'
� 5�
MAIL
ADDRESS USE ZONZe OCCUPANCY BIC po
.:AifeP-
CITY �� TEL.NO. • b siis I,e7 �
CONTRACTOR
ADDRESS vv ` .„
JOB N0.
CITYTEL.NO: TRUNK PERMIT N0.
STATE
REGISTRATION NO.. COUNTY, ROAD-.PERMIT NO.
'DESCRIPTION ANO. ' STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT -C �j�C / INDUSTRIAL
WASTE APPROVAL
812E OF LOTNOW ON LOT
NO.OF BLDGS.
6 X�. CHARGES
USE OF s
BUILDINGS CONNECTION CHARGE E
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER a $ 8.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR / yI D_' E EPTION R,S,ORDED
WORK TO,HOUSE SEWER 1.60
ALTER OR REPAIR EXISTINGNO I 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 STATION- T �� DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE RFF.ERFNf•F
ER -LOWER---
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 tib' Y,— CU•R
AUTHORIZATION TOTAL FEE ,��, ,4��'�OrL
'I HAVE.THIS DATE CONTRACTED WITH THE HEREIN NAMED '
CONTRACTOR.TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO-THE PUBLIC SEWER
SIGNED THIS-.--.-.—.DAY OF...... 19 _. NEWHOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..._.._..__.._._..._......�___.-.._-.._-„. -_._ BUILDING OR WORK SG 6C� 4-
SEPTIC
ADDRESS.................•-_-._.._..................................................... AND/OR DRAINF ELD IT(S)
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 A HE LEGAL OWN-
ER OF THE ABOVE D SCRIBED ESIDENIT P OPERTY. BACKFILL SEPTIC TANKS
SIGNATURE'. SEEP.PI•T(S)[] CESSPOOLS
OF PERMITTEE._:.._..._ -._.._..._._...._ . .. ._... ._........ _ ..... '
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