HomeMy Public PortalAbout9112 OLEMA ST_Sewer__ a8AE-60
ri�ec�3.!55 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
C ASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
LEGAL OWNER
LOT NO. '
BLOCK TRACT 3 MAIC,
AODRESS
NO.. OF BLDGS.
SIZE OF LO'T t NOSV ON LOT S:T:'I' TEL. Nu.
USE OF
BU ILII1NGS _ _ DISTRICT GROUP MAP
BK. PG
-�
CONTRACTOR -� - �
ADDRESS CONNECTION DATA
TEL-L- NO STATION , D E P 7 H
STATE MANHOLE REFERENCE
REGISTRATION NO, ❑ COUNTY ---- .--.-_--...-�" -. ,+—'- _.-__—=t LOWER
xo.. DESCRIPTION OF WORK FEE ------ --- --- —_-__ _ _-- �
'9' [-OLSE. GFv'ER CNNG _- TYPE OF CONNECTiO P.L. LENGTH
ENGTH PF,RLO,
M
ONETITY. CURB
PUBLIC SEVER3.50 P
`
HOU5E SEAcR CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 --------- .------- ------.
._ _. P N O.
CONNECT ADDITIONAL Bt.DG. OR
O HOUSE SEWER 1.04� CO. tAI P. NO_� —30B NO.
ALTER OR REPAIR ESTSTING -—.,.--SEWER OR DISPOSAL SYSTEM 1.00 _ TRUNK PERMIT NO_`-. .ROAD PERMIT NO.
DISCON NECI AND ABANDON SEWER STATE ENCROACHMENT
__ AzD/OR DISPOSAL SYSTEM 1,00 _ PERMIT NO.
T
SEPTIC ANY SEEPAGE PIT OR - �-' --- ----"- --
�� PITS AND/OR DRAINFIELD--_ .00 INDUSTRIAL
C'_SSPOOL-DRY-VELL V WASTE APPROVAL
P£CIAL Cq_N(II IONS ONLY 2.00 _ _ _ CHARGES
PERMIT $ 1 00 CONNECTION CHARGE FEE
OVINEWSAUTHORIZATION TOTAL FEE — REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THEABOVEDF_SCPIDED L'XISIING DWELLING APPROVALS �- DATEd
tSPECTOR"$SSG3VATUR6
TO THE PUBLIC SEWER
SIGNED THiSv._:�.'.--DAY — 19�_.` NEW HOUSE SEWER
- -- l
- �� CONNECT ADDITIONAL ____ . __._._,-_�_...__w..- .
0`NNER OR � � BUILDING D ITION.
OWNERS ,'-,GENT_..-._....-._. _ .— _..._.----- -
SEPTIC TANK, SEEP, PIT(S) � E
AN /OR DRA'.N_FIE_LD
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYT.tiELL O --
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. SE'SAGE DISPOSAL SY5TEM _
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 ABANDOT' HOUSE EWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS C
.SEEP. PIT(S) � CESSPOOLS�]..
SIGNATURE �
OF PERMITTEE..�_.v..:-_,.�
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF F`LBG. INSPECTOR
x
fBQB 3.i•:3. - APPLICATION FOR PERMIT
EAE»GC
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL d
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING
- LOCALITY ` j
NEAREST
FOR APPLICANT TO FILL IN CROSS sT. 4
�o
LEGAL
DESCRI P710N LOT NO OWNER
�-'�-- -._- MAIL L✓''.
BLACK TRACT - ADDRE+SS�yf-�---"- ._.- '-�r--j�,
rte.
NO. OF BLDGS.
SIZE OF LOT ( NOW ON LOT CITY J.,," _ iL'.� ,7 T.L.
USE OF
BUILDINGS DISTRICT N:O, ROUP MAP PROCESSED BY
BK PG
CONTRACTOR
ADDRESS ��ly' CONNECTION DATA
CITY TEL, NO. STATION -�. J DEPTH
j.r
STATE - LIC MANHOLE REFERENCE
LICENSE NO. CLASS -. Y'.
NO.. ' tDESCRIPTION OF WORK FEE TYPE OF WCONNECTION�� , LENGTH FROM
H0
OUSE SEER CONNECTING TO Y. CURB {P.L. ,� M.L.TO P.L. ,yip -
PUBLIC SEWER @ $5.00 P.C.NO.
SEPTIC YANK SEEPAGE PIT OR
I CO.IMP. NO._Y y ,',.� JOB NO. _— L,j
PITS AND OR DRAINFIELD @ $10.00
HOUSE SEWER CONNECTING TO i� TRUNK PERM]
OUSE ' ROAD PERMIT NO.
! PRIVATE DISPOSAL SYSTEM @ $3.00 _
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIYEx EASEMENT RECORD,INSTR.NO. DATE
WORK TO HOUSE SEWER @ $3.00 �"
—�I OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $5.00 ifb
ALTER.-REPAIR OR ABANDON HOUSE HWY.OR 57.WIDENING
SEWER OR DISPOSAL.SYSTEM @ S3.00 I STATE ENCROACHMENT `
PERMIT NO. ^_
—�-- - INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT g y 0 CHARGES
" -- ----' - CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE —
1 HAVE AT THIS DATE A CONTRACTWITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS T
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF - —
OWNER OR MEW HOUSE SEWER
OWNERS AGENT___,_ CONNECT ADDITIONAL
BUIL-DING OR WORK
ADDRESS____ _ - _ SEPTIC TANK,SEEP,PITS)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ----,-.. ----- --- --
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL OR THAT 7 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RfSt6f IN, THE ABOV DESC RISEO RESIDENTII AI PROPERTY. ABANDON HOUSE SEWER I
SIGNATURE _3 q: ,�. r J-( BACKFILL SEPTIC TANKS ❑
OF PERMTTTEE �,f-_-_� "'SSSsss... 4-Z "W ��'"' SEEP.PIT(S) ❑ CESSPOOLS ❑
ATION JACK R. ALLEN
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CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER