HomeMy Public PortalAbout9148 OLEMA ST_Sewer__ 76A6420
E
5 .6559 82•K4
APPLICATION V PERMIT
E ■MIT 1
�
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE AGE D i S POSA,L
Deportment of County Engineer
County of Los Angeles
TADDRESSG%WM.J. FOX, COUNTY ENGINEERCASSATT D.GRIFFIN,SUP'T OP BUILDING CALITY
FOR APPLICANTTO FILL IN AREST
CROSS ST,
LEGAL -
DESCRIP7[QN LOT N0. OVINER -
BLOCK TRACT - MAIL
NO.OF SLDGS,
SIZE OF LOT .NOW ON LOT CITY, TEL. N.O.
USE OF�--+
BUILDIN 5 D[S%RICi'.NO. :GROUP ! MAP -
K
CONTRACTOR
—y -
ADDRESS ' - - - - CONNECTION DATA
CITY - TEL. 140. STATION DEPTH
_ J_4TATE : MANHOLE REFERENCE - w~
REGISTRATION NO.+ ;T "j. �►.. '..� L-.I COUNTY --- -_ .__rrc —_LOWER
i DESCRIPTION OF WORK TYPE OF CONNECTION _M-. .LENGTH F°.L.
NO,
P^.Ly M.L 0 P.L.
HOUSE 5EV1ER CONNECTING
1'0 -
._1PUBLIC SEWER_
HOUSE iEWiR CONNECTING TO
_t PRIVATE DISPOSAL SYSTEM .T 1.00
CONNECT ADDITIONAL BLDG. OR.V.
y I CO. IMP.N0. !CB_N0. ,—
WORK TO HOUSE SEWER _ 1.00
ALTER OR REPAIREXiSTING -
i ° 4'7ER OR DiSPO5AL5YS'EM _ 9.00 I TRUNK PERMIT N0, ROAD PERMIT NO..
U SG NNECT AND ABANDON SEWER —� STATE.ENCROACHMENT
AND/OR DISPOSAL SYSTEM _ i.Ofl_ PERMIT NO. .—
SERTIC TAN{ SEEPAGE PIT OR "
DRAINFIELD __2.00 I INDUSTRIAL
CESSPOOL DRYWELL �- � Imo.._—' VPASTE APPROVAL.
SPECIAL CONDITIONS ONLY 2_00 I —� CHARGES
—2
O RS PEF3NUT CONNECTION CHARGE FEE — -- —_��---
$ - t 00
AUTHORIZATION TOTAL FEE � � REIMBURSEMENT FEF'
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS ( LATE INSPECTOR-'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESC;IPED EXISTING DWELLING —11- ---
TO THE PUBLIC SEWE;t ( —
SIGNED THIS
_—.,.-�... DAY OF NEW HOUSE SEWER� 19.«.-+--�� __. -
OWNER OR ""���'``J''�� j� j CONNECT ADDITIONAL -
OWNERS AGENT'' 1' � °�" '' .,�" �-� �' _ PUILDING OR WORK _ —
SEPTIC TANK, SEEP,PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOA LLDG£ THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELLLl i
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITH 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 -`—"-`--J"'""`—'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i AM TI-iE LEGAL OWNER OF THE ABOVE ABANDON.HOUSCSEVffR _
DESCRIBED RESIDENTIAL PROPA' RTY. - �- BACKFILL.SEPTIC TANKS 0
.SEEP. PIT(S) CESSPOOLS ice.
SIGNATURE
OF PERMITTEE
WILLIAM J. FOXCOUNTY ENGINEER VALIDATION
BY RY: _
DEPUTY DEPUTY
BY BY .
DEPUTY DEPUTY