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Home My Public Portal About9144 OLEMA ST_Sewer__ 642D61 6AA642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWED-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A4 LAMBI£, County Engineer ADDRESS WILLIAM A. 1ENSEN, Supt of Building LOCALITY NEAREST x BUILDINGS FOR APPLICANT TO FRI IN CROSS ST. LEGAL i DESCRIPTION LOT NO. r' OWNER + BLOCK TRA ., NAIL i/ t -•'' ADDRESS 0.OF BLDGS. SIZE OF LOT NOW ON LOT a CITY TEL. NO. USE DISTRICT NOGROUP MAP PROCESSED BY aB% PGCONTRACTOR 4 ADDRESS GONNEOTATA CITY TEL,NO. STATION DEPTH G' STATE MANHOLE REFERENCE UPPER REGISTRATION,KO' ® COUNTY LOWER NOJ DESCRIPTION OF-WORRK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $.3.00 TYPE OF CONNECTION LENGTH OM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.T O.L. ITS AND/OR DRAINFIELD @ 53.00 OVERFLOW SEEPAGE PIT,DRAINPIELD EXTN..CESSPOOL,DRYWELL @ $2.00 d HOUSE SEWER CONNECTING TO P,' o NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP, NO. CONNECT ADDITIONAL TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER S1.00 O ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHM€NT r H SEWER OR DISPOSAL SYSTEM @ $1.00 _PERMIT NO.. j 4: INDUSTRIAL i' CL WASTE APPROV Y V) CIIARG z OWNER'S PERMIT s 2 00 CONNECT10I CHARGE FEE AUTHORIZATION I TOTAL FEE =} '* ' REIMBURSEMENT FEE `L I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER, SIGNED THIS DAY OF 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT. BUILOiNG OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL 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 DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT _I AN THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDENT)AL PROFERT) SIGNATURE ` .a -3 ;, � y SEEP.P1T(S ❑ CESSPOOLS OF PERMITTE o- I {' " v,AIMATION--`� ROBERT A. WOOD cK K.o. I CASH SUPERVISING MECHANICAL.'ENGINEER 'E808 A642D6' '4A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING pOHN A, LAMBI£, County£ne.�inegr ADDRESS WILLIAM A. JENSEN, Supt of Suifding LOCALITY NEAREST FO LICAM T CROSS ST. LEGAL DESCRIPTION LOT N �L ''/ o OWNER s - MAIL BLOCK TRAy,, ADDRESS SIZE OF LOT N OH LBLDGOT CITY ,'TEL. NO. USE OF BUILDINGS DISTRICT ND. GROUP PROrSS MAP ED BY --- BIC PG CONTRACTOR Y_ ADDRESS4L CONNECTION DATA CITY ; TEL.NO, STATION ✓. DEPTH f J STATE MANHOLE REFERENCE REGISTRATION N0. [I COUNTY ` d LOWER NO. I DESCRIPTION OF V7 R.K FEE � HOUSE SEWER CONNECTING TO PUBLIC SEWER P S3•00 I TYPE OF CONNECT IO LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB f.t M.L,TO P.L. r PITS AND/OR DRAINFIELD @ S3„00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL Ca $2.00 a HOUSE SEWER CONNECTING TO ",>' P.C,N0. 0 PRIVATE DISPOSAL SYSTEM C $1.00 CO. IMP. NO. JOB NO. U CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0. WORK TO HOUSE SEWER $1.00 m ALTER,REPAIR OR ABANDON HOUSE ( STA7E ENCROACHMENT 0 SEW R OR DISPOSAL SYSTEM @ $1.00 PERMIT NO, u INDUSTRIAL WASTE.APPROVAL a' en CHARGES Z OWMR'S PERM 51 2100 CONNECTION CHARGE FEE AUTHORMATION I TOTAL FEE =_ REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPIROV= DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWE SIGNED THI DAY OP 19 hi I NEW HOUSE SEWER CONNECT ADDITIONAL OWNERS AGE IT e BUILDING OR WORK ADORE S�S' SEPTIC TANK,SEEP..PIT(S) AND/OR DRAINFIELD I HERE Y AMNO LEDGE THAT t HAVE READ THIS APPLICATION AND STATE THAT T E ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,5EWERO PLUMBING AND SEWERS. SEWAGE DISPOSAL SERR OR I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT D CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE BACKFILLS USE TANKS DESCRIBED RESIDENTIAL PROPERTY. ❑ SEEP.PIT(S ❑ CESSPOOLS SIGNATURE ;! �` ._r,;�'� - OF PERM ITTEE_X .Qy'`l, '. , r VAI.IDATI0;, ROBERT A. WOOD CK. M.C. CASH SUPERVISING MECHANICAL ENGINEER , S � 7