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HomeMy Public PortalAbout9409 OLEMA ST_Sewer__ .E8°6 Z"° '6.A E320 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FAIDE'� NG © � JOHN A. LAMBIE. COUNTY ENGINEER SS 9sCOLEMAN W. JENKINS. SUPT. OF BUILDING "{TY `�pMpJLSeNEARETIA ♦ V A_VeOR APPLICANT TO FILL IN sr. ;PRINT OR TYPE ONLY) --_.__-_ ---_--- __- Z �.L-.. f if. � .-._._ DESCP PTiON LOT NO OWNER ohn ��/*,�� 1J�`If� {- yry .(..'1 MAIL r� BLOCK TRACTJj 1..7410 ( Lf nta lJ„i v } ADDRESS P.O.. $®x_1 SIZE OF LOT 60 ,x .L J.. NOWOONB LOTLOGS 0 CITY A��.°>�,d�„`�, TEL. NO. 286-q822 USE OF __j-- - ISTR:CTNO. OUP CLAS1.41 PRCCEASFJ BUILDINGS S � -� 1e BK ,. ppy� �. _CONTRACTOR5-08- 32 ADDRESSCONNECTION DATA _ .�- ' �'�a'��� TEL. F' Z STATION 1 32 DEPTH lot STATE ✓, LIC MANHOLE REFERENCE y LICENSE NO: �/ t,r �:Y' i,6�'�L CLA SS _C ,-•-'� 4r ,1 18 t , o LOWER Nd. . DESCRIPTION OF WORK FEE --_ . _ _ TYPE O�'CO NNECTfON LENGTH FROM t HOUSE SEWER CONNECTING TO .__ ( ,.fir` r CURB P L. M.L.TO P.L. '�'4 PUBLIC SEWER SS-OCT -}I---+.i,(= - SEPTIC TANK.SEEPAGE PIT OR ppppY�ry P.C.NO, PITS.AND/OR DRAiNFIELD @ $1000 CO. IMP.NO. JOB NO- PITS SFWER CONNECTING TO - _ PRIVATE DISPOSAL SYSTEM $3.00 THUNK PERMIT NO. ROAD PERMIT N�:_, � _ _ — 0 CONNECT ADDITIONAL BL,OG OR AFFIDAVIT T wAI VER EASEMENT RECORD.IN TR.NO. DATE WORK TO HOUSE SEWER @ $3.00 ___ EXTN.CESSPCOL.DRYWELL-MANHOLE @ $5.00 HWY. OR ST.WIDENING ALTER,REPAIR OR ABANDON HOUSE t - 4.. SEWER OR DISPOSAI SYSTEM __.. STATE ENCROACHMENT � _ yy 'y�i �] PERMIT NO with`yY 1�}l0$i��►__'ryti.�} YE3 �p /__rte I INDUSTRIAL_- EY i h late .a3._ t(� £ /-�.__ _- _ W A5TE APPROVA__ f CHARGES .�OWNER�S PERMIT - -- - ,. o© -- - .--- -- ---- -- AUTHORIZATION TOTAL FEE ,. GONNECr1oN CHARGE FEE 1 HAVE AT THIS DATE A. CO ACr WITH THE HER � NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT T'. A .YE DESCRIBED E TING DWELLlN -TO THE PUBLIC SEWER". / APPROVALS DATE INSPECTOR 5 SIG.NATUR.E SIGNED TH15^._ 71 OF 19_ --- OWNEROR .y NEW HOUSE SEWER OWNERS AGENT - CONNECT ADDITIONAL --_ - —-- -- --- ADDRESS BUILDING OR WORK " -- SEPTIC TANK,SEEP. PIT iS) I HEREBY ACNNOWLEOGE THAT I HAVE READ THIS APPLICATION AND;OR URAINFIELD AND STATE THAT THE ABOVE .5 CORRECT AND AGREE TO COMPLY ----.- -- - _ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL 0 I HEREBY LICECERTIFY TH glR?1 AM. PROPERLY RE�G5TE RED AND/OR ALTER.REPAIR.SEWER 0R ---I�- LICENSED AS REO a LOS ANGLES NT,* AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR OR T A 7HM _f:q AL OW ER AND INTEND TO DISCONNECT PLUG AND RESIDE IN, TH 8 Y DE5CRI REST NTi L.PROPERTY. ABANDON HOUSE SEWER SIGNATURE T TI] .. J)_ CF PERM .+` - ..y 'P { BACKFILL SEPTIC TANKS I "�---""`—'- SEEP. PIS) ❑ CESSPOOLS [j VALIDATION _ JACK R. ALLEN SUPERVISING MECHANICAL. ENGINEER CK. M.O. CASH 16A 642D -CE808-10-71 APPLICATION FOR PERMfT +./f COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING . ADDRESS � - LOCALITY FOR APPLICANT TO FILL IN CROSS NEAARESST. -' LEGAL DESE CRIPTION LOT NO. OWNER MAIL - BLOCK TRACT ADDRESS NO. OF BLDGS SIZE OF LOT - NOW ON LOT J CITY 0 '"�!' TEL. NO. USE OF a.z.=---� BUILDINGS DISTRICT NO. GROUP I MAP PROCESSED BY BK P$ CONTRACTOR .41aR_ESS ) „>-- a. CONNECTION DATA STATION .,,. DEPTH STATE LIC MANHOLE REFERENCE UPPER LICENSE NO:~ GLASS = J- NO, 1,, DESCRIPTION OF WORK FEE TYPE OF CONNECTION ,�.� LENGTH FROM `"�� HOUSE SEWER CONNECTING TO Y. CURB P.L.! M.L.TO P.L. PUBLIC SEWER 0 $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR CO.IMP. NO. JOB NO. PITS AND OR DRAINFIELD 0 $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. / d PRIVATE DISPOSAL SYSTEM 0 $3.00 O CONNECT ADDITIONAL BLDG,OR AFFIDAVIT wA1YER E.SEMENT RECORD.INSTR.NO. DATE V WORK TO HOUSE SEWER a $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD �� EXT N..CESSPOOL DRYW ELL, _ @ $5.00 _ HWY.OR ST.WIDENING O AIR ALTER.REPOR ABANDON HOUSE h SEWER OR DISPOSAL SYSTEM —_-- $3.00 2 STATEENCROACHMENT V W MANHOLE PERMIT NO. $7.00 - INDUSTRIAL y WASTE APPROVAL b CHARGES OWNER'S PERMIT s 3 00, AUTHORIZATION I TOTAL FEE g T y '` CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEW$R- J�/ ✓” r APPROVALS DATE INSrTOR'S SIGNATURE SIGNED i-HISj_-_'k;z DAY OF /✓ 9_ a OWNER OR NEW HOUSE SEWER O W N E RS A - 1, CONNECT ADDITIONAL �, Y/("�' IBUILDING OR WORK ADDRESS_ J - SEPTIC TANK,SEEP,PIT(S) ' IH ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRA{NFIELO AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY TN A�T I AM PROPERL 9 EGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED �Y LOS ANGLES UNTY ND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT.. THE THE LEGAL O, OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THEAB d CRIB£D RE -EN PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PER M177.&E SEEP.,PIT(S) „r4SSPDOLS ❑ VALIDATION CK. M.O. CASH