HomeMy Public PortalAbout9132 OLEMA ST_Sewer__ ,
a E-669 11.55 - APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS 'k
JOHN A. LAMBIE, COUNTY ENGINEER ------- —
I) CASSATT 0. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN r doss ST.
LEGAL^
DESCRIPTION LOT NO �- -r .. ¢ ' .- - OWN WR—
BLOCK TRACT Y t ,4DG1tES5 _
NO'OF BLDGS --- CITY 'r,r TEL.
IZ
SE OF LOT NOW ON LOT
USE OF- � - -- - � ,
BUILDINGS r _ r _ e - DISTRICT NO. ! GROUP MAP
BK PG
CONTRACTOR - I Ft' .7 $
CONNECTION DATA
ADDRESS --- - - --------- - _
STATION - DEPTH
CITY TEL. NO, -- � �-_ # i _
MANHOLE REFERENCE_ -_ UPPER;:
[] STATE ` ` y
-- -�.�._� - �.,_ f �—LOWER
REGISTRATION NO. Ll COUNTY
NO. DCRIPTION OF WORK FEE
C'S --- — --
---—� ----- --- - -- TYPE OF CONNECTION LENGTH FROM r
-- --- --
HOUSE SEWER CONNECTING TO .a Y. CURB P L M.L.TO Y.L.
PUBLIC SEWER �: S 3,50 I I -------------�-.— —.--__
�1 SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD
OVERFLOW SEEPAGE Piz DRAINFIELDP C, N0, -
PXTNi,CESSPOOL,DRYWELL,,MANHOLE (a $2-0_0; CO. IMP. NO, �• _JOB NO. —
HOUSE SEWER CONNECTING TO �f
4 PRIVATE DISPOSAL SYSTEM fns $1.00 i ! TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG..OR STATE ENCROACHMENT
.-WORK TC HOUSE SEWER a $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE 1 - --�--- ----
INDUSTRIAL
SEWER OR DISPOSAL SYSTEM- $1.00 WASTE APPROVAL
-- -- --- -- - - - I- —�
CHARGES
CONNECTION CHARGE FEE
OWNER°S PERMIT 1 00
..—_.
-------------- -- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE �y
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA ED CON. APPROVALS DATE �INSPECTOR'SSIGNAIURE
TRACTOR TO CONNEC" THE ABOVE D-ESCRT BED EKISTING DWELLING
TO THE PUBLIC S EW'F?.. NEW HOUSE SEWER
SIGNED THIS DAY OF r -_t3 - ADDITIONAL-- -
------ CONNECT
OWNER OR BUILDINtOR WORK
OWNERS AGENT �,�,.z SEPT]
_- ----- _ ,.----- - ---- ..
P. 3 (
,=`-`---'-.. .-'-- PT7 TANK,SEEP PIT(Sf
ADDRESS-__i...._.�. " � y -��s-r -.. , ':N-D/Ok DR4.INFIELD------^f
I HEREPY ACKNOV.1Lc DtE THAT 1 HAVE. READ THIS. APPLICATION CESSPOOL DRYIWELL U
di PaD SLA7r.. i' Al THE ABOVE IS CORRECT AND A(R€E. 'TO COMPLY _. _ _--- -_,_-... —
WITH ALL COUNTY ORDINANCE'S AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR I I
PLUNIBiNG AND SF"WEBS. SEWAGE DISPOSAL SYSTEM
i HEREBY CERTIFY THAT t .4M PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS RECUIRED BY LOSANNGELES COUNTY AND STATE OF I
CALIFORNIA OR THAT I AM THE LEt-:AL OWNER OF THE ABOVE ABANDON HOUSE-SEWER--
DESCRIBED RESIDENTIAL PROPERTY. 8ACKFILL SEPTIC TANKSL
SEEP f f (S) i_, CESSPOOLS.:
SIGNATURE
OF PERMITTEE—�.�.__
JOHN A. LAMBIE,COUNTY ENGINEER VALI.)DATIM" ROBERT A, WOOD, CHIEF PLBG. INSPECTOR
,.j.'R'
CK. It. C. CASH
int S t
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