HomeMy Public PortalAbout9141 OLEMA ST_Sewer__ S76AS42D&r-663 i2-54 APPLICATION. FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depaar�tmient of County Engineer
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County of Los Angeles BUILDING.
Ox COU
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ADDRESS
WM.J. FOX, COUNTY ENGINEER
N Sjp"0_,U.L.It�G LOCALITY
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CASSATT 0.GRIFFIN.Sup"r OF SUILt)ING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
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DESqRlt_TfON LOT NO-,='
OWNER
BLOCK TRACT z MAIL
ADDRESS
x NO.OF BLDG$
SIZE OF LOTY, NOW ON LOT
CITY TEL, NO.
USE OF
BUILDINGS
DISTRICT NO. GROUP BK MAP FG
CONTRACTOR
CALIF.SEWER CONST.U.
ADDRESS 1317-t-01E-680YE Ayr CONNECTION DATA
CITYuNTZ 11
-,E -2ELL0— TEL- NTA. -5-048 STATION DEPTH
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0 STATE MANHOLE RErERENCE
REGISTRATION NO. 14 F, COUNTY P�i E LOWER
8,6 59
TYPE OF CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y, Gains P.L. _M_.L.._Y0 P,L,
SEWER CONNECTING TO
tIL3L�'S.S Eyc R (9- $ 3.50 'rt 3
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSALS STa7M 1.00
CONNECI.A DDil"Ll UNAL SLDG� OR
?.RK TO HOUSE SEWER 1.00 1;O_ IMP-NO. JOB. NO.
ALfCR OR REPAIR EXISTING
SEVIPR OR DISPOSAL SYSTEM SSSS l.c TRUNK PERMIT NO. ROAD PERMIT NO�
lLiANDON SEVIER STATE ENCROACHMENT
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4M1' OR S S-rEm I,uo
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SEPTIC T�'kNK, SEEPAGE PIT OR PERMIT NO�
P)TS AND/OR DRAINFIELD 2.00 :MDUSTRIAL
NASTP' APPROVAL
CE-,-3`P60__-OR Vi'F
S?EA, CONDITION 'ONLY
CHARGES
CONN'ECTION CHARGE FEE
OwwwS PERMIT 00
AUTHORIZATION TOTAL FEE REIIABURSEIAENT Fr E_
I HAVE 111HIS DATE CONTRACTED WITH THE HEREIN NAMED CDN-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLIW.. APPROVALS j DAT E INSPECTOR'S SIGNATURE
10 THE. Pu�ql_l
.z NEW HOUSE SEWER
SIGNED THI-SY.:,- - DAY OF
OWNER OR '0NNrCT ADDITIONAL
OWNERS A G E NT__ J,
SEPTIC TANK, SEEP. PIT(S)
HFR79Y ACKNOWLEDGE THAT' I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL 0
A N D STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STAVE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE: AB OV E AS_A N DO Pt H 0 U SL.SiEIN ER
DESCRIBED RESIDENTIAL PROPE?ty. BACKFILL SEPTIC TANKS E3
SEEP.PIT(S) CESSPOOLS(2,
SIGNATURE
-y
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY
BY BY
cp) DEPUTY DEPUTY