HomeMy Public PortalAbout9111 OLEMA ST_Sewer__ S&E-56
513�-569 1.2-.54 APPLICATION FOR PERMIT 1 _
DIVISION OF BUILDING .AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING.-
WM.J. FOX, COUNTY E.NCINEER ADDRESS` r -�
CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY
FOR .APPLICANT TO FILL IN NEAREST
LEGAL GROSS ST'.
- --
CE5CRIPTSON L03'NO, � OWNER
BLOCY. 7P,ACT "' a MAIL
ADDRESS.. C '
N0.OF BLDGS, ,
SITE OF LOT __ NOW ON LOT
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USE OF
BUILDIh CS__ _r /� _4 If v� _ DISTRiCTY O. jI GROUP MAP ,
CONTRACTOR ~. 4 a!, BK PG�.-
ADDRESS' { �., CONNECTION DATA
CIT�i TEL. NqZ _ STATION DEPTH
yr Li`STATEMANHOLE REFERENCE
REGISTRATION N0. � COUNTY Ic -LOWER
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�`-- TYPE"OF CONNECTION LENGTH FROM
no. I DESCRIPTION OF WORK FEE "B P.Lw__,41.L O P.L. _
HOUSE SEWER CONNECTING TO
PUBLIC SEWER_ C'_$ 3.50 --
��
HOUSE SEWER -ONNECTING TO
PRIVATE DISPOSAL SYSTEM _ t 00 (_' _ - - -- ----.----_ .--
CONNECT ADDITIONAL BLDG. OR
�,✓ CC. IMP. NO JOB. NO.
WORK TO-HOUSE SEWER_ 1.00
ALTER OR REPAIR EXISTING �E���—
SEWER uR D'SPOSAL SYSTEM _ 1.00 TRUNK PERMIT NC, ROAD PERMIT N0.
1
DISCDNaIEcT AND ABANDON SEWER
I ANS OR DISPOSAL.SYSTEM t 00 I;' STATE ENCROACHMENT
PERMIT NO.
SEPTIC TANK,SEEPAGE.PIT OR ----' — -----_�T_
-- P'TS AN.Di OR DR_AINFIELD 2.00 INDUSTRIAL
CESSPOOL fl+2Y'W 'WASTE APPROVP:L
5 ECTAL CONDITIONS ONLY 2.00 _ CHARGES
-- —"- CONNECTION CHARGE FEE
OV1NEB'S PERMIT _ _
AUTHORIZATION N - TOTAL FEE FEE
y
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I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED IC CON- APPROVALS DATE INSPECTOR'S SIGNATURE
CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWE LILAC
TO THE PUBLIC SEVER
,� N P,1 HOUSE SEWER
SIGNED THIS_ rf YOWNER
_ CONNECT ADDITIONAL
OWNERS oi�E.4 f'C•. �' ; � '_....r', - "s_ BUILDING OR WORti�!
<y- ' •'.' SEPTIC TANK, SEEP, PIT(S)
ADDRESS— z'--I-- _ AND/OR D_RAIN_NELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL CI_�-
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. SEWAGE DISPOSAL SYSTEM
I HEREBY' CERTIFY THAT I AM PROPERLY REGISTERED AND/OR —`-'� --
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL RROPERTY. .-- BACKFILL SEPTIC TANKS 0
SEEP. PIT(S) C1 CESSPOOLS,�:I _.. -.Y_..�._...r_
SIGNATURE
OF PERMITTEE_ �a
WILLIAM J. FOX, COUNTY ENGINEER VA11DATION
BY BY
DEPUTY DEPUTY
BY BY
® DEPUTY v. DEPUTY