HomeMy Public PortalAbout9129 OLEMA ST_Sewer__ I
:E606 10-63
6A6420 APPLICATIONFOR PERMIt
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUiLnINC .
JOAN A. LAMBIE, Counts Engineer ADDRESS r 'P44
WILLIAM A. JENSEN, Sup'i of Building ------ --
LOCALITY g
MEA R JE
57 X
FOR APPLICANT TO FILL IN CROSS
LEGXL
DESCFIFTION LOT NO / OWNER
—._
y MAIL
--BLOCK! ., TRA.^. ✓ :_: / j ADDRESS
f
SIZE OP LOT .0 .'4 + NOW ON LOT CITY 'TEL, NO.
USE Or
BUILDINGS Jp 4;_..� � �Vit:=- t-�?� DISTRICT NO. CROUP MAP PROCESSED BY
—_—_ HDC PG
CONTRACTOR/.,
ADDRESS C NI�IECTION DATA
STATII:N - DEPT'H
CITY t� y �.. +. TEL. NO.: Y
a
SCATS _
REGISTRATION NO j t COUNTY MANHOLE REFERENCE
LOWER
-N—O-- GESCRIPP I'OS�C?F'W"OR1r FEE ----TY -OF'CO
_ TYPE OF'CflNNECTtE�N - LENGTH PROM
HOUSE SEWER CONNECTING TO Y. CURB 'P L. M.L.TO P.L.
PUBLIC SEWER G.4 $5.90
PTICIN'.T4NK,SEEPR.GE:'!'T OR - � .; P.G.h0, '-
y
PITS AN'D/OR DRAT NF ._ Ij
I ED 8t.,.00 CO. P. NO. JOB NO.
T t HOI;;nE SE'1M ER CONNECTING TO !SUNK PERMIT NO. ROAD PE.R:hVT"NO.
PRIVATE DISPOSAL SYSTEM
LGN NEC:7 ADDITiONA BLDG OR AFFIDAVIT wAtYt4 Sas€.wf M1t' RECOD.RINSTR.NO. DATE
,
WORK TO HOUSE SEWER —
_—
'
OVERFLOW SEEPAGIE Pf7,DRAIN FIELD _
EXTN
-,CESS POOL.ORYW cL L,MANHOLE &5.00
-_. _ - _ .___._�._______ "HWY.OR 5'i.WIDENING - -" `
ALT ER.RE PAIR OR ABANDON MOUSE T -,/
.1_� _. -_
!.SEWER OR D'SPOGAL SYSTEM - _ ,—83_00- STATE ENCROACH MENT xs
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
��+p.OWNER`S _PERMIT 2, 00
_—__ _____—. .__---.CHARGES __—__—.__.--__ --__
CO
AV HORIZATION TOTAL FEE x CONNECTION CHARGE FEE
'IHAVE AT THIS DATE A CONTRACT W11,H THE HEREIN-'NAMED CON- R`'"IMBU_RSEMENT.FEE
TRACTOR TO CONNECT THE .ABOVE OFSCRIBFD FX: r NG DWELLING ------ -- - ----TO T'Hk PUBLIC- S WjERAPPROVALS
DATE IN PECTOR 5 SIGNATURE
SIGNED THIS sAv of --
OWNER OR NEW HOUSE SEWER j:-
CG"vVNFRS AGENT ; A ..•.4
TiON
ADDRESS .:'' (
CONNECTBDNG ORWORK
c� �-.. `-^ __ - —.'*ra.____ SEPTIC TANK,SEEP PIT(S)
BY ACKNOWLEDGE THAT 1 HAVE READ 'fH 3 APPLICATION ANO/OR DRAINFIEL.D
AND ST-ATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING1
PLUMPING AND SEWERS. CESSPOOL ^� DRYWELL !'I '
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND,/OR A_T'ER,REPAIR,SEWER OR �
LICENSEDAS RFQU(RED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL!FOR'N IA OR THAT I AM THE LEGAL OW ER OF, AND INTEND TO --- "---- --�-" T""---`--` '"- --- "-"--"
DISCONNECT PLUG. AND
Pr51DE IN. THE .ABOVE DESCR(BE.o RESIDENTIAL PRPPERTY.
ABANDON HOUSE SEWER
4 -.
SIGNATURE _.1_—_-_—_—'.__—__.__—_.._ _.___..
> � - _
1 :t`,f -/ 9, BACKF ILL SE.YIICTANKS
— - ,�] I -
OF PERMITTEE, ✓'--'e, -+i-+.�-;`.—.�-4.,€,•:.:'� I-
.aEEP.PIT(S.1 J CESSPOOLS
VALIDATIO {. ROBERT A. WOOD
''.SUPERVISING. MECHANICAL ENGINEER
CK. M.P. CASH -
°au.Y3 6 5'3 iwi{ 4 .,.. V i1 7.0 -