HomeMy Public PortalAbout9669 OLIVE ST_Sewer__ D
S&E-6C3 11=55 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County EngineeLFR County of Los Angeles BUILDING
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JOHN A. LAMBIE, COUNTY ENADDRESS
LCASSATT D. GRIFFIN, SUPT OF'13UILLOC ALIT'Y
NEAREST
FOR APPLICANT TO FILL IN CROSS 57.
LEGAL J--`-- -- _ OWNER
DESCRIPTION LOT 1i0.
- - -
MAIL
BLOCK TRACE ADDRESS
NO.OFBLDaS.
SIZE OF LOT NOW ON LOT CITY TE:L. N0,
USE OF
BUlLDI$GS DISTRICT NO. I GROUP IAP
---- -
BK PG
CONTRACTORADDRESS
CONNECTION DATA _
— - _- -s — STATION DEPTH
CITY` _ L n— - _.-- -._ MANHOLE REFERENCE 4 �` UPPER
STATE ---- -- — h _x r _ LOWER,
REGISTRATION NO, 4 ❑ COUNTY � � -.
NO. DESCRIPTION OI WORK FEE - ----- -- - --- -
- TYPE of cgtETfOrt LENGTH FitOM-
HOUSE SEWER CONN EGTTNG1 0 --- Y �eroRg'. P.L, M7 L. TO P.L. T..
PUBLIC S E vV E R. _ @ $3,50 --------'--
SEPTIC TANK,SEEPAGE PIT OR ---- — T - - �`�
PITS AND/OR DRAINFiELD n $3.(0 I --
�.� OVERFLOWSEEPAGE PIT,DRAINFIELD — -- T— � _.....� P, C. NO.
YIN :.CPSSPOO;,,DRYA.ELL.,MANHOLE /z $2.001 CO. IMP NO.
I HOUSE SEWER CONNECTING !O
-i
PRIVATE DISPOSAL SYSTEM _ __— .C( $i.00 I TRtINh PERMIT NO, ROAD PERMIT NO.f
CONNECT ADDITIONAL BLDG OR _ -:T �--- STATE ENC.ROACHMFNT - '-- -.- ---- - -
W0RKTO H0US_ 5ErrI.R C S 1.00 1 PERMIT NO.
,ALTER,REPAIR CR ABANDON HOUSE INDUSTRIAL:
!
SEWER OR D Sa05A L SY TE'Yi WASTE APPROVAL
1 - - CHARGES
CONNECTION CHARGE FEE
OWNER'S S PERMIT1 Do --- ---------- .__—.--------- -- -- --- -
-- — REIMBURSEMENT PEE
A€TTI�Ot�ta ATIOi�t _7COTAE FEE
I HAVE AT THIS DAT= A CONTRACT WITH. THE HEREIN NAMED CON APPROVALS ALS FATE i INSPECT OR S 51 NATURE
-- - -
't`RACTGh 10 CONNECT THE A&011e DESCRIBED EXISTING DV FS LINGTO THE PUBLIC 5Z•_6"-R.
NEW HOUSESEWER I
SIGNED TN15 _.--_DAY GF._.._.v_— ._.19 CONNECT ADDITIONAL --
OWNER OR BULLL)ING OR.WORK
OWNERS
SEPTIC SEPTIC TANK,SEEP,P17(„).
AN-0/0H DRtAINFIELD
I HEREBY A K 6h LEL:,GE THAT 1 HAVE READ THIS APPLICATION CESSPOOL(_] DRYWF.LLL_! [ � -
A?tG ,,I,+ E ih,M1M THE.A..�4F. [5 CORRE:�
CT ,ND AGREE TO COMPLY ---_. .._------. ----!- ----- _..-----._.
4V.!TH ALL. c OUNTY ORDINANCES AND STATE LAWS REGULATING. ALTER,REPAIR,SONER OR
PLUMAI G AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY cEPTTFY YHAT i AM PROPERLY REGISTEREDANP/OR SCO -- ---.--.-�-�`—._
LICE14SED AS RP L�LIF SCC BY .LOS ANGELES COUNTY AND STATE O.F. DiSCONttrCi PLUC,SND
CALIFORNIA OR ,.ri,.T I:AM THE LEC,.kL OWNER OF THE ABOVE ASA.NLON HOUSE SEWER
DESCRIBED RE..SrcENT;AI_ PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE _ SEEP. PIT S _.I CESSPOOLS r I- ------- -
OF PERMITTEE
IOHN A. LAMBIE, COUNTY ENGINEER •"=TION ROBERT A. WOOD, CHIEF PLSG, INSPECTOR
CM. HI.0. CASH
!6A6420APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los AngelesBUILD
ING r
JOHN A. LAMBIE, COUNTY ENGtFIEEF A➢DREssv ,
P CASSATT O. GRIFFIN, $UP'T OF BUILDING
- - LOCALITY S
FOR APPLICANT TO FILL IN CROSS S m
_CROSS ST_'
LEGAL ..._-
DESCRIPTION LOT NO :>r - y � ,_� OWNER
MAIL _ 7
BLOCK TRACT '� _ <� ,'` '.Y 'ADDRESS_—�.;_ L�
NO./F BL / CITY TEL. NO,
SIZE OF LO,� -. N PN LOT
USE OF 7 - -
BUILD - DISTRICT-NO. I GROUP MAP
_"
BK PG
CONT TCR 'A., 1
-- -- -- g
CONNECTION DATA —
ADDRESS ,! =-w� 6`:-a...:`� ,.-----_•-- -- ---- ---- ------
-� STATION DEPTH
CiT' .. TEL: N41. .vim"{..._- ,L l
--- - — _---_ ',;'- HOLE REFERENCE UPPER
S'...TE -- --.� s LOWER_
REGISTRATION NO. L" ,, ;y [] COUNT/' ��- >� {a _ ✓ _
N0. DESCRIPTION OF WORK FEE
- ---- -- --- - - --- -- TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO � f Y. CURB P.L. M-L. TO.P,L.
PUBLIC SEWER— @
�� SEPTIC TANK SEEPAGE PIT OR - -
PIT$AND`OR DRAINFIELD ca) $3.G0' -- -,-- -. ---- —_._-- ----____ ...---
OVERFLOW SEEPAGE PIT,DR;AINFIELD I P C. NO.
EX N.,CESSPOOL,DRYWELL,MANHOLE .! $ E.OvI CO, IMP. NO. -_______JOB N0.
--- ----------- ----------- -.*-------- - -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM kv $1.00 I I .TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADD'TIONAL BLDG OR �' STATE ENCROACHMENT
WORK TO HOUSE SEWER ER lit £1.0C If PERMIT N'3 --.-- --- --- .._.— --- ,-'--
r ALTER,REPAIR GR ARAN Dt)N HOUSE �-- - — -- -
SEWER OR DISPOSAL S`$TEM �c $1.00 1 INDUSTRIAL
---y- -- -- _.._- ----- _- I __..._..} ...�_ WASTE APPROVAL
II I I CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT — — -------
-- REIMBURSEMENT FEE
AUTHORIZATION TOTAL-FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS l DATE 7NSPFC1OR'SSIGNAYURF
TRACTOR TO CONNECT 'C Ii E: ABOVE DESCRIBED EXISTING DWELLING '
TO iHE: PUBLISE'iER. NEW HOUSE SEWER
SIGNED THIS—.—DAY OF 13--- CONNECT ADDITIONAL — —. ---� -- --
OWNER ORBUILDING OR WORK
OWNERS AGENT_— —.._ TN --- — -
--"—'" ---- SEPICTANK,K,SFEP.PIr(S)
ADDRESS—.—__ AND/OR DRAINFIELD
I HEREBY ACKNOVdLEDGE THAT i HAVE READ THI5 APPLICATION CESSPOOL;) DRYWELLD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ _ - �__ _.._�_-_.._.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING. ALTER,-RFPAIR,SEWER OR
PLUMBING AND SEWERS. ; SEW E DISPOSAL SYSTEM
( HEREBY C IFS THAT I ANI PROPER REGISTERED A — -- — —�.— ---- -
' xSCONNEGT PLUG AND
LICENSED A EOUiRED by LOS ANGF..LES ,C„�O;UNTY AND O - - !
CALIF Atr R Ti't(T t AM THE kEGAL i°*R' E F Ty{ 0.' ABANDON HOUSE SEWER — _ __--
IB vttES JN•ftAy PRQ,°%Rk <' .3'•` BACKFILL SEPTIC TANKS❑ ----- -
./ .•� ' SEEP. PIT(S)[! CESSPOOLS[]-
OF PERiii ITTEE_SIGNATr
i
IOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. R.0, �IkSH
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