HomeMy Public PortalAbout9838 OLIVE ST_Sewer__ I +DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE 61gT- Z
DIVISION OF BUILDING AND SAFETY PERMIT APPLl�ATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING -
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING kj NEAREST
ADDRESS _� /�f Y CROSS ST.
LOCALITY
"msµ~ DISTRICT NO. SERIAL NO. PERMIT NO.
� p7' f~ r.
NEAREST S
CROSS ST. - -
RECEIVED BY Ready for Inspection DATE ISSUED
OWNERS .�
MAIL a ` USE ZONE OCCUPANCY MAP
ADDRESS s— Cf��,rr{''. BK PG
CITY f t'a3fY r TELAO.
CONTRALTO l ����•• CO.IMP.NO
ADDRESS
JOB.N0. r ._.. .
CITY TELAO. TRUNK PERMIT NO. — -
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL ! 1 STATE ENCROACHMENT
DESCRIPTION L07 N0. PERMIT NO.
BLOCK - r INDUSTRIALd "
WASTE APPROVAL
�r
SIZE OF LOT h N0.OF BLOGS. o
NOW ON LOT / CHARGES
USE OF
BUI DINGS, gf_ a4. :_ CONNECTION CHARGE FEE
NO. I DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
—SHOUSE SEWER CONNECTING TO
PUBLIC SEWER $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL-BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 k
ALTER OR REPAIR EXISTING NO- DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 i CONNECTION DATA
ASPECIAL
EPTIC TANK,SEEPAGE PIT OR
ITS AND/OR DRAINFIELD 2.00 { STATION DEPTH
ESSPOOL—DRYWELL
CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT $ I I 00
Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE I -
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..._4,P B ``➢ NEW HOUSE SEWER
_.....DAY OF.... ..:. '�'-...---_...._....19: ..'
OWNER OR pp I CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT 45..
¢g`> , ° r - SEPTIC TANK,SEEP.PIT(S)
ADDRESS.. �...�-•-- }-± ---4._/s' ---C.:S ..........................•--..-... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] 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
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE.--- -� - '
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