HomeMy Public PortalAbout9104 OLEMA ST_Sewer__ a E•6fi3 92-�d
6p
S£k _ APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING '' s
ii`.IM.J. FOX', COUNTY ENGINEER AD3RF..S5
GA««ATT O. GRIFFIN,,Sua..r OP BulL.olrac LOCALITY
FOR APPLICANT TO FILL IN CNEAREST
ROSS ST.
---LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACTr
�7� .��� MAIL �
} _ADDRESS
,� - NO.OF BLDGS. +�
SIZE OF.LOTY - ;:, ,G� r. NOW ON LOT 1 CITY TEL. NO.
USE OF v — 1---
BUILDINGS
_-- DISTRICT NO.: I GROUP MAP
SK PG
CONTRACTOR C4 1f" SEWER CONST CO
ADDRESS 331T=2 E AIE CONNECTION DATA
CITY MONTEB I TEL. N!p 1_!;04 v STATION DEPTH
-�— iii Q STATE .. MANHOLE REFERENCE
REGISTRATION NO. 148S,$9
485 (STATE) Q COUNTY UPPER _ _..._
TYPE OF CONNECTION LENGTH FROM
NO, ` DES'RIPTION OF WORK FEE Y. `:UrS P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO i
—•I PUBLIC SEWER ®R $ 3.50 -
I F t, c SEWER CONNECTING TO -
_ PRIVATE DISPOSAL SYSTEM 9 00 f - -
CONNECT ADDITIONAL BLDG, OR —` I CO. IMP.N0. JOB. NO.
1 Wr KTO HOUSE SEWER _ - 9.00 I _ `._
ALTER OR REPAIR EXISTING TRUNK PEis.'sI1T NO. ROAD PERMIT N0.
SEW_R 0 DISPOSAL SYSTEM 1.CO..I�._..` : _ _
I S NP C T AND Ef NC0N SEWER T I � STATE ENCROACHMENT
DISPOSAL SYSTEM ^9.00 _PERMIT NO.
SEPTIC 7 CNK SEEPACE PIT OR INDUSTRIAL
_-
_�f P AN OR -2AHf9 IELD 2.00 INDU TRIAL APPROVAL
f -FOOL - RYi4 LI
SPE Ai CONDITIONS ONLY 2.0'0 - CHARGES
-- -- ----- —' -I'-- - --
j
--'�-' CONNECTION CHARGE FEE
OVN `S PERMIT � I t i 00�
AUTHORIZATION TOTAL FEE ^� I Y � 11 EIMBURSEMENTq FEE �x
1. 9iAr THIS DATE .CON"iRACTEO `v?'iTH 7Ht. HERE iV NAMED CON- APPROVALS I DATE INSPECTORS SIC-NRTURE
TRA JR TO CONNECT THE A$ VE DESCR GED EXISTING D WELLING `-.._�`
TO THE PUBLIC e Yv R. ��'°I -_- - ' - ' --
s __ E--, '_.. NEW HOUSE SEWER �.
$IGt'tO THIS.,- DAY OF i`3�.-�
OWNER OR t. iA {��I I� CONNECTADDITiONAL
OWNERS AGENT a '.A �, _ _BUILDING OR YuORK
r. SEPTIC TANK, SEEP, PIT(S)
__A R/OR_DR-.AINFIELD
HEREBY A KNOYWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL Q DRYW'ELL[}
AND STATE THAT THE ABOVE IS CORRECT .AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING: ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS, ALTER,
DISPOSAL SYSTEM
I HFRFBY CERTIFY THAT I A,'. PROPERLY REGISTERED AND/ORLICENSED AS A.S RFO�J,RF,D BY LOS ANGELES C04iN1'Y AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS 0 -
r SEEP.PIT(S) LQ, CESSPOOLS Y_,,
SIGNATURE
f
OF PERM ITTtE
WILLIAM J FOX, COUNTY ENGINEER VALIDATION
By PY
DEPUTY DEPUTY
BY BY
€Pi DEPUTY DEPUTY