HomeMy Public PortalAbout9415 OLEMA ST_Sewer__ 7 r
6A 642D-CE806-10-71 APPLI CATI N FOR PERM
COUNTY OF LOS ANGELES SEWE -SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY
NEAREST
FOR APPLICANT FILL IN =ROSS
-LE
-_- GAL .. ti -
D_ESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT - ADDRESS
NO. OF aL6Gs.
SIZE OF LOT NOW ON LOT CITY T.L. N.2
USf OF DISTRICTNO, GROUP` MAP PROCESSED/. BY
BUfLDI _ _ @K P'a J.�.
fiONT RACTO �`�- `-r' -' ... 2-
_-- _
ADDss �' CONNECTION DATA
a v EL. N STATION. DEPTH
STATE e� LIC MANHOLE REFERENCE UPPER
LICENSE CLASS LOWER
N
-DESCRIPTIO14 OF WORK FEE TYPE OF CONNECTION LENGTH FR{i6l
HOUSE SEWER CONNECTING TO y , Y. CURB P.L. M.L.TO PL.
PUBLIC SEWER $7.00 [ P.G.NOyy
SEPTIC TANK.SEEPAGE PIT OR CO.IMP.NO. JOB N%/
PITS AND DRAINFIELD 510.00 }
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. Rt) D PERMIT NO, a.
PRIVATE DISPOSAL SYSTEM @ $3.00 0
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT rA.1.11 -EASEMEN CORD.INSTR.NO. DATE V
WORK TO HOUSE SEWER $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD W
EXTN.,CESSPOOL.DRYWELL. $5.00 HWY.OR STWIDEN}1�i�b• O
'ALTER.,REPAIR OR ABANDON . .DHOUSE y
SEWER OR DISPOSAL SYSTEM $3.00 — u
- -- - STATE ENCROACI 1L
MANHOLE
$7.00 PERMIT NO. d.
__ fA
INDUSTRIAL Z
WASTE APPROVAL
CHARGES
OWNERS PERMIT $1 3 00
AUTHORIZATION I TOTAL FEE f`} &I 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 SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE T COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS R ULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL Cl
I HEREBY CER FY T I AM PROPERLY REG tSTE D AND/OR ALTER,REPAIR,SEWER OR
LfCE NSED AS Q BY LOSe
COUNTY A D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA T I AM TH LNER D INTEND TO
' DISCONNECT PLUG AND
RESIDE BOVE DES BENTI ;P ERTJ'Y ABANDON HOUSE SEWER
SIG TUR
PE rrTE CKF LL SEPTIC T;griKS ❑
SEEP. ITSS) CESSPOOLS ❑
VALIDATION � 'CK M•0• CASH
;.ice OCT 1 0 13 1 CIL 0"` ca
-E808 2/70
V6A 64ZD APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL Ll
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
I '
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS I E. Olema S ,
COLEMAN W. JENKINS. SUP'T. OF BUILDING
LOCALITY
_!2e
FNEAREST
R APPLICANT TO FILL IN CROSS ST. __N -1k
LEGAL
_A_VeL__
(PRINT OR TYPE ONLY)
OWNER
_Ou�F!-�PT 10 IN LOT NO. John Marshall
MAIL
BLOCK TRACT #27410 (t4ntative ADDRESS
_p.0
NO-
_SiZE OF LOT 60 x 112 NOW.1N.L.G5, 0 0 LOT CITY Arcadia TEL, NO.
286-9822
USE 0 Gs DiSTRJCTNO OUP ILAIS
BUiLDIFN Single Family Res . (P ed 1AP PROCESSED 13v
n9pM(__
X
CONTRACTOR
ADDRESS CONNECTTOPI DATA
STATION DEPTH
6--�Ccf, N 0.
_f�E TA LIC
MANHOLE REFERENCE
C.L Ar. LOWER
LICENSE NO: d.
NO. DESCRIPTION OF WORK FEE__ Y. TYPE OF CONNECTION LENGTH OM
HOUSE SEWER CONNECTING TO CURB P.L. M.L TO L
PUBLIC SEWER
_Z P.C.NO.
sEpTic 6�WK.SEEPAGE PIT OR CO.IMF. NO. OS NO.
j PITS AND/OR DRAiNFIELO SIO.00
HOUSESEWER CONNE_CWNG_TO____ TRUNK PERMIT NO. ROAD PERMIT-N;
PRIVATE:DISPOSAL SYSTEM @ $3.000-
---I—___ A 0
rCONNECT ADDiTIONAL_I3I:DG_OPCASENIENT I—RE RD.INSTR.NO.
WORK,TO HOUSE SEWER @ $3.00
6VERFLOW SE.EP_AGE_PIT.OR
EXTN, POOL.DRYWELL..MANHOLE $5.00
__-1 -- � _1_-___--_ ----,--4 HWY.OR ST.WIDENING 0
ALTLR,_R_E-AIR OR ABANDON HOUSE
_SEWER ORDISPOSALSYSTEM $3...00 __STATE E�NCROW(�HMEWT
u
PERMIT NO. LL)
-OUiTRJAL
IN WASTE
APPROVAL
th lateral to CHARGES
ovmws PERMIT00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ;
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIM-OU'RSEMENT FEE
TRACTOR. EXISTING
TO CONNECT THE ABOVE DESCRIBED DWELLING
TO THE PUBLIC
SSW ER DATE INSPECTOR'S SIGNATURE
SIGNED THIS Ay OF
L
OWNER OR NEW HOUSE SEWER ee_
e�
OWNERSAGE T,
CONNECT ADDITIONAL
BUILDING OR WORK
_,tDDRESS
SEPTIC TANK.SEEP.PIT(S)
I HEREBY AC=KNOWLEDGE THA'! I HAVE READ YHIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W�TH ALL COUNTY ORDINANCES AND S"'ATE LAWS REGULATING
P,1;M BING AN V SEWERS. CESSPOOL, [7j DRYWELL
THAT !5�� PRO�11(51LY REGISTERED AND/OR ALTER REPAIR,SEWER OR
T 1
I I�Fi A�,Z;�"4�N-�Y AN1.1 STATE OF SEWAGE DISPOSAL SYSTEM
0 IRE
C AT 1 r T AND
INTEND
To DISCONNECT PLUG AND
RESIDE I T ZO ES(� �E
IE 0 OR., RTY- ABANDON HOUSE SEWER
SAC
SIGN R
rT
I/PER rr SEE KFILL.SEPTIC TANK
3-------— P.PIT is) CESSPOOLS
VALIDATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK. M.0 CASH
L)