HomeMy Public PortalAbout9403 OLEMA ST_Sewer__ '6A 642D-CE808-10-71 APPLICATION FOR PERMIT
I 'fl
BOUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F,-".0
DING/'' 7 ti '
E...,LITY
NEAREST -y---FOR APPLICANT TO LL IN CROSS ST.
DESCRIPTION LOT NO. _ OWNER"- _
MAIL
BLOCK TRACT jx ! ADDRESS
NO.. OF BLDGS. r"
SIZE OF LOT
NOW ON LOT- -- CITY TEL. NO.
USE OF �9
BUILDINGS l'f DISTRICT ND. GROUP MAP PROCESSED BY
BK p5
[' 1
CONTRACTOR �.>` - �'..Cr ...3.' '•-�_ G-- �- ,��_
Ao S ,. r CONNECTION DATA /
-- __EL-NO STATION DEPTH
STATELIC •� MANHOLE REFERENCEr'' l 1 UPPER
LICENSE NO,• C:LA �® 1 LOWER
O. I DESCRIP IO OF WORK FEE TYPE OF CONNECTION —ENGTH FROM
HOUSE SEWER CONNECTING TO y Y. CURB P.L. M.L&O P.L.
PUBLIC SEWER
SEPTIC TANK.SEEPAGE PIT OR P `,
PITS AND/OR DRAINFIELD $10.00 CO.IMP.NO. A T'10•
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. AD% PERMIT NO:. d
PRIVATE DISPOSAL SYSTEM $3.00 i' 0
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAI It -E [NT E ORD.INSTR.NO. DATE u
WORK TO HOUSE SEWER @ $3.00 j
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL,DRYWELL. @ $5.00HWY.OR ST. ?EN'ING
0
-
ALTER,REPAIR OR ABANDON HOUSE � � V
SEWER OR DISPOSAL SYSTEM _- @ $3.00 STATE ENCROJkCHMENT p uJ
MANHOLE — _-_-- $7.00 PERMIT NO.,�' _ (L
-- --------'------------ - INDUSTRIAL.
WASTE ANDROVAL Z
OWNER'S PERMIT $ 3 00 CHARGES
AUTHORIZATION1 TOTAL FEE :, CONNECTION CHARGE FEE
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLISEWER. APPROVALS DATE INSPECTOR'S SIGN URE
SIGNED THIS DAY OF 19_
r c..-
OWNER OR NEW HOUSE SEWER
OWNERS AGENT ------ --
CONNECT ADDITIONAL -
BUILDING OR WORK
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY --WITH ALL COUNTY OROI NANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL. ❑ DRYWELL ❑
IHEREBY CERTIFY THAT�/AM PROPERLY STERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED 4!'$ 110S ANGLES C TY D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I.AMY THE LEGAL O D INTEND TO _.
RESIDE IN, THE ABOV IASC IBED RESID�NTZ O'F*E RTY. DISCONNECT PLUG AND
(fir�� ��°° �/' ABANDON,HOUSE SEWER
SIGNATURE .+'' \,7 ` 4 , BACKFI L SEPTIC T,A N7(5 ❑
OF PERMITTEE J°°'- [p
SEEP.PIT(5) p,CESSPOOLS ❑
_VALIDATION " CK. M.0. CASH
Li" n p .G "'