HomeMy Public PortalAbout9703 OLIVE ST_Sewer__ 7SA6420
3&E-66311.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER' ADDRESS
CASSATI D. GRIFFIN, SUPT OF BUILOING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN _CROSS ST.
LEGAL
DESCRIPTION LOT NO, OWNER
MAIL
BLOCK ADDRESS
NO. OF RLDGS. TY TEL. NO.,�
--
SIZE NOW ON LOT Ci
USE OF
DISTRICT NO. GROUP I MAP
BK PG
CONTRACTOR _X'
ADDRESS C FC7QX DATA
STTION DEPTH
CITY TEL
MANHOLE REFERENCE
STATE
REGISTRATION NO. -CZUa_27
DESCRIPTION OF WORK FEE ON
hHOv3v_SEV,IER CONNECTING TO T"E OF CONNECTION LENGTH FROM
Y CURB P.L. M.L� TO P,L,
PUBLIC SEKER cLql Y.
7
SEPTIC
E jT-fCTA j
EEPA&E�_Fa R
AND/OR DRAINFIELD $3.001
� .
OVERFLOW SEEPAGE PIT, DRAINFIELD PCNO.
ENTN.,CES POOL,DRYW ELL,MAN HOLE (Q') $2.00 Co. wp� ,40.j JOB NO.
-------------
f HOUSE SEWER CONNECTING 10
PRIVATE DISPOSAL SYSTEM, ("i $1.0c, 1 TRUNK PER143T NO. ROAD PERMIT No
CON NEC'_ADD1T_1_0NA_LBLDG-._0_R ____
STATE ENCROACHMENT
WORK TO HOUSE SEWER PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SnVq-0--R DISPOSAL SYSTEM 4 s I-110 !NDUSTRIAL
WASTE APPROVAL CHARGES
CONNECTION CHARGE, FEE
OWNER'S ERMIT Q
AUTHORIZATION TOTAL FEE 3
REIMBURSEMENT FEE
I HAVE AT TIHIS DATE A CONTRACT WITH THNAMED CON-
E HEREIN APPROVALS DATE hNSPECTOWSSIGNAII URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PIUBLIC SEWER. NEW HOUSE SEWER
SIGNED TI41S____DAY CONNECT ADDITiCNAL
OWNER OR --BUILDING OR
OWNERS AGENT—__-------- SEPTIC TANK,SEEP, PIT(S)
ADDRESS ...AND/OR DRAI N-F I ELD _—
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CES SPOOL D CRYWELI_L
WITH ALL COUN'Y ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREB'� CERTIFY THAT I A�Mi PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS RE=RED BY LOS ANEGELES COUNTY AND STATE 0"' ABANDON_HC-USE SEWER
141
CALIrORN7A OR THAT 1 ASI 1E LEGAL OWNER OF THE ABOVE
DESCRIBED
RESIDENNAL PR BACKFILL SEPTIC TANKS
6EEP.PIT(S) CESSPOOLS 1-1 1
SIGNATURr
OF PERMITTEE
IOHN A. LAMBIE.COUNTY ENGINEER VALIDATION ROBERT A. WOOO, CHI'EF PLEIG. INSpPECTOR
CK M.0. C.AS14
V1
0 1 65 ANN 2 2 5 A 2 5 0
E.6c•5$�
v
"s 9 1155
APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles 0UILDI%G -
JOHN A. LAIviiBtE, COuNT'Y ENGINEER ---u—
' CASSATT D, GRIFFIN, Sur•TOFBUILDING LOCAL[IY J' -.�
NEAREST `- � �
_ FOR :APPLICANT TO FILL IN CROSS ST ?
LEGAL J `, .,` _JY. _-- - e .w —,
DESCRIPTION LOC N0. O\JNER
MAIL .N .: ..-✓
BLOCK
TRACT < -... ADDRES3ILf I, -
--^NO.OF BL - .--- CITY TEL. NO"
SIZE OF LOT NOW ON LOT USE or
�-- - —
_ DISTRICT NO. GROUP MAP
BUILDINGS_ '� �< - >✓ _�
— � BK Pc
CONTRACt.OR.-
.y_
. CONI3�CTIOlo1' DATA - --�'-
ADDRESS ..d.r`✓'. `"', �+', .' _ - ,. - - --
o y ya I014 DEP H
CITY ,9"x , . 9 jTENO. .�`� G:_ � 41ANHOLE REF
£RKNC 'd ---
y Q STATE i � N ��'
REGiSIRATION NO ° i J_� ``� 0--, 4 r-,.-- j I �..
NO. ; DESCRIP iON OF WORK FEE �
YHOUSE SEWER CONNECTING TO------- --_ `- ,TYPE OF CONNECTION LENGTH FROM Y r
r Y - CURB P L. M L TO P.L.
PUBLIC SEWER @ $3.50 ----
SEPTIC TANK,SEEPAGE PIT OR
PI7, ANDt OR _cZ INr IELD ._- —
OVERFLU+v SEEPAGE PIT, DR.4INFIELD P. C. N0.
I E:ITN.,CE SPOOL,DRYWVELL,MANHOLE (4 $2.00 CO. IMP. NO. r ,� JOB NO.
:'
HOUSE SEWER CONNECTING --
PRIVATE DISPOSAL SY tEVI (0). :$1.00 j ! TRUNK PERMIT NO. ROAD PERM T N0. ,�
CONNECT AUD TICNA[.BLDG.OR —�--- STATE ENCROACHMENT ---
w.ORK TO "OliSF.' S6 EIR (". $1.C.0 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSc --- --- -�---------
SEWER OR DISPOSAL SYSTEM {t 4 f,LiC I i INDUSTRIAL
--_ --— -- - ---- _.---1--.-I------ WASTE APPROVAL.
` CHARGES
A CONNECTION CHARGE FEE
OWNER'S PERMITo
EE— _ REIMBURSEMENT F
� _ �� � t
AUTHORIZATION TOTAL FEE i-�
APPROVALS GATE I INSPECrL ,-.;';AT;RL-
I HAVE AT THIS DYE A CONTRA WITHTHE HERFIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
To liiE PUBLIC YWER. � NEW HOUSE SEWER �
SIGNED 1 _—DAY OE �$ � 193CONNECT
-- — --- --- -- - --
_ C(iN NFCT ADDITIONAL
-OWNER ORBUILDING OR WORK
OWNERS AGENT,_____ _ ,..-K 5 ---- - ----- __--�I--_--- -_- —--- ----
-
_ -- SEPTIC TANK,SEEP.PIT(S) l
7DDRL5S °s ._ 4- r I= �� AICD/OR DRA:INi•IELR
1 HIRES
ACKNOWLEDGE OWLEDGE THAT I HAVE READ THS APPLICATION CESSPOOLLI DRIWELLjD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUN7Y ORDINANCES AND, STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUIt9R NC AND SEWERS, SEWAGE DISPOSAL SYSTEM
-C.ri E1:;Y C R I='Y THAT D"I AM PROPERLY REGISTERED AND/OR- ------ ---— ------ -'-y----�--�-----------
DF5CONN£C'f PLUG AND !
LIGE?iSED AS Ri U'RED 6 v5 A'vCELES COU'N'TY AND STATE OF ABANDON HOUSE SEWER !
C-LFORN A T..AT I AV, THC LEGAL OVIkI k OF THE ABOVE --`-- -.._.---_--_--- _�._-- -..�_,--------_.--
DESCP EU RES I F tNL PROP t T( jr BACKFILL SEPTIC YANKS
SIGNATURE SEEP.PITS ❑ CESSPOOLS -- ,...
OF.YRMI1'T£E '•.'-.,- °r .al Jt r
t`
1OHN A. LAMBIE, COUNTY ENGINEERS :VALIDATION ROBERT A. WOOD: CHIEF FILBG. INSPECTOR
AHR 22 45
ex
y
.—