HomeMy Public PortalAbout9847 OLIVE ST_Sewer__ 7z+A7E1,42D 2 APPLICATION FOR PERMIT
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COUNTY Of LOS ANGELES SEWER—SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 6 t
JOHN A. LAMBIE, County Engineer -"
WILLIAM A. JENSEN, Supt o3 Building ADDRESSLOCAL
NEA RE5C
FOR APPLICANT TO FILL IN CR7S5 ST
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.ESCR T,ON LOT NO. OWNER
MAIL,
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NO. OF' BL.DG.S.
fi.IZE OF Lf:T NOW ON LOT CITY TEL. NO.
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ADDRESS ��' � �� ; 4CONNECTION DATA -`
A STATION DEPTH
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��:a �--F ., y'�K. STA YE $ UPPER
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REGISTRATION NO U
NO. I I7ESr Rn"1 LGN OE WORK '-EE TYPE r+F '1 fJ[ T (TN x- LENGTH TK FROM - —
HOL.SP SEW€R CCDNN ECTING TO I =••' �; Y. �cUR ,f' t) M.L.TO P.L. �.
r'USLIC SEWER
.,�.-,.6 0
�SEPTIE.YANK,SEEPAGE PIT OR -- _ -- - - 2' I . y JOB NO.
PITS AND CSR DRAI NF lELD @ $10.00 COIP4P N{] __ZL ____JOB
1IOJJ9E SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERM T NO. I - t..�7 0
_1 R7 dAT"'-D Sf OSAL S'YSTE'M $3.00 V
P — _ -__ ___. ___ .___._— _._ -
CONNt.':_ ADQI ZONAL BLDG OR t. A'=FIDAVI.T t.WAIVER�'EASEMEN I RECORD NST NO.-_� DATE
V, RK 10 HOUSE SEWER $3.00
EX N,;;ESSPOOL,DRY-W LL.,MANHOLE'0 55 00 HWY.OR ST.WIDENING
ALTER.REPAIR OR AB a�JDON HOl15E I ——
SEW._P OR DISPOSAL SYSTEM + $3.00 I ---._ __._...- --------
STATE
STATE ENCROACH NIENT
PERMIT NO.
INDUS'CRIAL -
WAS'rr APPROVAL l
OWEER°S PERMIT ! al oo - - -- --: -- - - - --
-'— —. CONNECTION OHARGF FEr
AUTHORIZATION TOTAL FEE ' # -- -_�- ----------------- ------------ -
I HAVE AT' 'HTS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT f_EE
TRACTOR T'; ^CONNECT THE. ABOVE DESCRIBED F.k.iSTING DWELL IryG _y9_,,++q_ fie__—_—_
To
T, E r(1
El IC SEW-Eft. .APPROVALS DATE INSPECTORS SIGNATURE
SIGNED TiiiS— DAY
OWNER.OR •' NEW HCJSE SEWER I'
--
OWN ECT,a•ia'_'.;ENT_._______— CONNECT ADDITIONAL.,_
BUILD•,NG OR WORK
ADDRESS ._._
__._ ---__ -._ _._ .. SFPYIC TANK,SEEP,PI7{S?
I
HEREBY ACKNOWLEDGE R.HAT I HAVE READ THIS E ATo ATIpN
AND/OR DRAINF ELD
AND STAT ' THAT THE ABOVE IS CORRECT AND
AGREE
TO LIMPLY _ _____ __—.._�.— �_____-____.� _._______—
WITH AL COUNTv ORDINdANCES AND STATE LAWS REGULATING i
PLUNISING AND SEWERS.. CESSPOOL j DRYWELL L-],
_-_-_— __...__ _-____..
I HrREB'.r CERTIFY THAT'`�i`AM P.;OPER LY RE�,IST€RED AND/OR AL R,Rt'F''AIF:,SEW Ef¢OR
LICENSED AS REQUIRE�A -rHE
A-OS ANGLES COUj6�TK AND STATE OF SEWAGE DISPOSAL.SYSTEM
CALIFORNIA OR THAT i LF AL,. OWNER OF�4ND INTEND TO 5CONNEC'T PL C NDkESID IN, THC ABCtWECRIBEDE:5hBANDON HOU E EVER
SIGNATUR= ✓ / �� BAC KF-ILL SEPTIC TANKS ❑ 1
OF f ERMITTEf _ SEEP..PIT(S) ❑ CESSPOULS. ❑i
VALIDATION ROBERT A. WOOD
/C K. M',D. CASH SUPERVISING M-ECHANICAL ENGINEER
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6A64
7 213 APPLICATIOWrOk PERMIT
6A6•'sD
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
.ADDRE
JOAN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Sup'i of Building
NEAREST 9
RDss
FOR APPLICANT TO FILL IN
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LEC'AL u
LOT NO 33
UESCRIP710N OWNER
:w, r MAIL
BLOCK T'RACTi( f - f.. ,l�j�t Af)��� ADDRE 5
— — `� _.
NO. OF SLOGS.
N
SIZE OF' LOT .NOW O -LO'r CITY TEL. NO.
_—_
U 5L" CF AI STRICT NO. GROUP MAP PROCESSED BY
.U. NGS —__ BK PG
CONTRACTOR .� - .L� '9pb' J� ✓ b,. ,Y-- ��,t L G ;, "�i
ADDRESS a -- /' N
� . CONNECTIO DATA
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STATION DEPT-N
CITY ti,w, � EL td O...F ./ 5 `Cr= ? --
d - 0 T,IFPER
_• ,�+y -'yy `X ,p BTA:TE MA`v HOLE,RIFERENCE '�
REGI h08c�.,.1 'Ar .;F' Yx=C1U NTY .'�J -L.:.rYScK' r
No., DESCRt TIbN OF WORK FEE '- - ---
.._— TYP ON LENGTH FROM `v
�' O F r N 78 CY
F OJ SE SEWER f ONNECTING 70 T Y. sr st F LM.L TO P.L.
PUBLIC-SEWER Q85.00
,-
P. �.— --- — --T --- - _.C.NO.0 TANK.K SEc rSAC'E PST OR
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JOB B NO.
PjTS AND?OR DRA N11FLCO. !MP NO.:D $10.00 U
HOUSE SEWER CONN TING. TO TRUNK PERMIT NO ROAD PERMIT NO. t
PRIVATE DISPOSAL SYSTEM $3.00
UNN GI +LID 1710NAL HLDO OR - -- --- - -- AFFIDAVIT WhI I€AGEMF NT RECORD. SNSTR.NO, DATE
WORK TOHOUSE 6VESEWER L 5300 -
—: E P
.Okv SPAC�F PIT.DRAIricIEi
;A _I
_—_
KTN CES�XOOL.DRY WELL.M
A'{,DC£'@ $500
, _ -- HWY.OR ST.WIDENING -
ALTER, AIR OR ABANDON �LJSE
I !
_—_--fi - A_C_- ME_—_.—.__ .__--______
_-4JALr$Y� M � ENCRO } N —_--
y
Pr'RMfT NO.
t_.,--_ _.,..-_-_-..-- INDUSTRIAL
I
WASTE APPROVAL
OWNFR's PERMIT
- CONNE
AUTHORIZATION TOTAL FEE D TION CHARGE FEE
---- ----� _
REIMBURSEMENT FE€
HAVE A'' THIS DAH'`E A CONTRACT WITTHE HEREIN NAMED CON-. ..____-. __. ._.- -__--
TRA C70R.TO C:C�N til k:CT THE A30VE DISC RIBED EXISTING DW FEEING
TO THE PUBLIC SEWERAPPROVALS DATE INSPECTOR'S SIGNA'T'URE
SiGNFD THIS DAY
OWNER OR NEW HOUSE SEWER
OWNERS AGEN:_. .____._- ___ _ !
_._ - —_ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRE
.--_ SEPTIC TANK,CE5-P PIT'{S)
1 HERESY .Ax tN YWLEDGE THAT 1 HAVE READ TM S APPLICATION r
- AND,t7R Da;AiNFIE..D
AND iTAY E: TH
',' 7rvE MHOYE lu CORRECT AND t1lzRE F_ '1'G. C<")3q k'LY I
WITH ALL COL:NTY ORDINANCES AND STATE LAWS REGULATING
PLUMB ING. AND SEWERS. CESSPOOL ❑ Dr? WELL ❑
HERF_BY CERTIFY THAI' 1 AM PROPERLY REGIS7g RED AND/OR ALTER,REPAIR,SEWER OR i
Li CENSED AS REG MIRED B' LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM �
A_.kFO!iid lA OR THAT I A ATHE LEGAL OWN-R OF, AND i.NTEND TO CSISCgNNECT P'UG AND
RESIDE 7N. THE ABOVE ES::R.1 Bf.D RESID TIAL PROPEi7Y. `
ABANDON HOUSE SEWER
SIGNATURE
OF PCRM'ITTE€ r'` - :0''L '.- BACKFIt( SEPTIC TANKS.
- ---'^•-- -" - -_'--- SEEP,PIT IS) ❑ CESSPOOLS ❑
'VALIDATION ROBERT A. WOOD
C-K.-: M_9. CASH SUPERVISING MECHANICAL ENGINEER
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