HomeMy Public PortalAbout9105 OLEMA ST_Sewer__ 6A 642D -CE808- 10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ABDU
DILRDNG
LOCALITY
NEARESTEST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT .7 MAIL
_ADDRESS
NO. OF BLDGS.
SIZE OF LOT (,NOW ON LOT CITY_j1_liAt)lp
USE OF 1
BUILDINGS DISTRICT NO. GROUP BK MAP PG PROCESSED BY
CONTRACTOR L�_
ADDRESS CONNECTION DATA
CITY TEL. NO. STATION Z 2 DEPTH
STATE LIC MANHOLE REFERENCE _ UPPER
LICENSE NO., CLASS -593 E
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. j,,' M.L.TO P.L.
PUBLIC SEWER 0 $7.00
P.C.NO,
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 0 $10.00 CO.IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. CL
PRIVATE D15POSAL SYSTEM 0 $3.00 0
7CONNECT_ADDITIONAL BLDG.OR AF_ ta EAsEmENT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER @ $3-00
OVERFLOW SEEPAGE PIT.DRAINFIELD
_EXTN,.CESSPOOL,DRYWELL. 0 $5,00 0
*WV".REPAIR OR AIM"WOFF4111110ftM HWY.OR ST.WIDENING
S 4".5 ' u
SEWER OR DISPOSAL SYSTEM @ $ "'C_ STATE ENCROACHMENT Lu
MANHOLE $7.00 PERMIT NO.
@
— INDUSTRIAL
WASTE APPROVAL z
CHARGES
OWNERS PERMIT E69
AUTHORIZATION 1 TOTAL FEE dull CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS.DAY OF _19—
OWNER OFA'
NNEW HOUSE SEWER
OWNERS NT - CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(S)
AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH.
ALL COUNTY ORDINANCES
_ES AND STATE LAWS REGULATING
PLUMB ING AND SEWERS. CESSPOOL [I DRYWELL ❑
1HEREBY CERTIFY THAT I AM 0 PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED
AS REQUIRED BY LOS ANGLES COUNTY AND STATE F SEWAGE DISPOSAL SYSTEM 1-P
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
IDE
BCD REBID AL
RES IN, TH ABOVE DESCRIBE RqPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PER El SEEP.PITS)
S) 0 CESSPOOLS
VALIDATION CK. M.0. CASH
V` 3PL 0
v
78A6APPLICATION FOR PERMIT
&
S E-65-653 f2:54
DIVISION 9F BUILDING AND SAFETY SEWER-SEWAGE DtSPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS -
CASSA.TT D.GRIFFI[N.,SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
- -
CROSS IT. _
DE.SCRIPTICN LOT NO ,---.--- CWNER ,.
BLOCK TRACT NAIL - -- - ----- ---
P.0, OF BLDGS.
SIZE f,f•I.flT tiOV11 ON LOT ----- CITY
USE OF
:E€. 14rJ.:
----- --�--- -
EU€LDINGS DISTRICT NO. GROUP ; MAP
I! 6 K PG
CONTRACTOR
ADDRESS — CONNECTION DINTA
CITY TEL. N( STATION - DEPTH �a
STATE ` IaAP'itri'L`�T"" FEgENCE
REGISTRATION NO. � COUNTY �X�..-�� � It. R ,F- � Lg}rt'iz__�
---�- - - - -- - TYPE OF CONNECTION }ENG N 171.FROA1 up .r' s
NO. j DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
�f PUBLIC SEWER rQ, S 3 SO
HOUSE SEWER CONNECTING TO I
PRIVA"4'.E 1�iGPGSAL SYS"CE!a _ 1.00 i �--. -_--------
CONNECT ADDITIONAL BLDG. OR CO N4 . . „�- �- �"� B "
WORK TO OUSE SEWER _ 1.00 ` _ -i—_.PNOJO . NO
- _B. N
1 ALTER OR Re.P.A 1R EXISTING ..��.-
SEWER OR DISPOSAL SYSTEMr.OD I TRUNK PERMIT NO. ROAD YLRIA;7 N0.
a
. CIS GOrdNFCf AND ABANDON DSEWER STATE- --- - EN
AND/OR DISPOSAL I' SYSTEOM 1.00
T ---- - PERIAiT NO,
SEPTIC TANK SEEPAGE PI1' OR "---"----
�i
PITS AND/OR DR,,4 NFtE.D 2.00 ItiDU..TRYAL��
CESSPOOL DRYWEt L-�� - - � 'tl F.-.£APPROVAL
_-� SPECIAL CONDITIONS ONLY- _ _ - ;10L!I CHARGES
- CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 11 00
AUTHORIZATION TOTAL FLEE � r�� - REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED V H THE 14"EREIN NAMED CON- - APPROVALS DATE yg �PS >=CT 'S S; N�T;;�'-_?
TRACTOR TO CONN'-ECT THE AEOVE UE!s"R r3FD E7 i tr 3_D f LLANG ---� _. 1....— _-
TO THE PUBLICV t,R �
NEW HOUSE SEWER
SIGNED THIS-
0
HIS -_
OWI- R OR - CONNECT ADDITIONAL
flr,Y .; BUILDINGR WGRK
SEPTIC TANK,SEEP,PIT(S)
ADD RtSS__._-...__.�._--: _ t D/CR DRAiNFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION F. CESSPOOL❑ DRYWELL[]��
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH
-
WIT'H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - ALTER, REPAIR,SEWER OR
FLUM61NG AND SEWERS. SEWAGE DISPOSAL SYSTEM
WER EY!V
CERTIFY THAT I AM PROPERLY RE,CISTERED AND/OR
LiCEHSNO AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF `DISCONNECT FLING AND
CALIFORNIA OR 'THAT I AM THE LEGAL 0WNER OF THE ABOVE ASA.PIDO N_HOU�SE�d ER _
DESCRIBED RESIDENTIAIL PROPERTY. EACKFILL SEPTIC TANKS[.I
SEEP.PITS) CI. CESSPOOLS Q;_.
5[C1QATURt°. -
__[_____
OF PERF1i17TE7_;.'
WILLIAM J. FOXY COUNTY ENGINEER VAIMATION
BY BY- zI i
DEPUTY DEPUTY
BY - BY. .
0 DEPUTY DEPUTY '