HomeMy Public PortalAbout9421 OLEMA ST_Sewer__ 6A 842D-CE8084 +D-1 - APPLICAT N FOR PERM
COUNTY OF LOS ANGELES SEW R-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING iE
ADDRESS �Cf
LOCALITY
NEAREST
FOR APPLICANT T FILL IN CROSS S -
LEGAL
_DESCRIPTION LOT NO. ER --✓
// / / MAIL
BLOCK TRACT / {�/' ADDRES5
NO. OF LDGS.
SIZE OF LOT NOW ON LOT CITY TEL. N
USE OF
BUILDINGS //!� DISTRICTNO.JGROUP MAP PROCESSED BY
L _ SK P+
GONTRACTO _ �J _y 1 ,
ADD E C� /� CONNECTION DATA
STATION DEPTH
i T !<..,N O.
STATE MANHOLE REFERENCE UPPER
LICENSE NO: '.LASS LOWER
N . I DESCRIPTIO OF WORK FEE TYPE OF CONNECTION LEN GTJFOM
HOUSE SEWER CONNECTING TO -may F Y. CURB P.L. M.L.T, 1.
PUBLIC SEWER a $7.00 / Cyf ''
P.C.NOt'
SEPTIC TANK..SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $10.00 CO. IMP.NO. JOB 1(Id.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. RO. PERMIT
PRIVATE DISPOSAL SYSTEM $3.00 o
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wa1vER EASEMENT ;¢E ORD.INSTRIIMP. DATE U
WORK TO HOUSE SEWER @ $3-00 1 1
_ 4
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.,CESSPOOL.DRYW ELL. @ $5.00 HWY.OR ST.WiDENIN O
ALTER,REPAIR OR ABANDON HOUSE F_
SEWER OR DISPOSAL SYSTEM $3.00 --- , U
-._._._ -- _ STATE EN CROACH ME
MANHOLE PERMIT NO. J L d
$7.00 — N
----- INDUSTRIAL Z
WASTE APPROVAL
OWNERS PERMIT $ 3 00.
i CONNECTION CHARGE FEE CHARGES
AUTHORIZATION1 TOTAL FEE
1HAVE 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 IN CTOR'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)
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT ANL2.,.4,GREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND .STATE LAWS REGULATING n
PLUMBING AND SEWERS. ` f-� CESSPOOL ❑ DRYWELL 41
I HEREBY CERTIFY TH A. AM PROPERk Y�*-REGATE�J�ED AND/OR ALTER,REPAIR..SEWER OR
LICENSED AS REQUIRE BY.LOS ANGLft._9044 Y,A'ND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA " AM HE LEGAL• / ND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE AB. E CRLISED �)GENTI j#.yERTY. ABANQON HOUSE SEWER
SIGNATURE
OF PERM(tYEE.__ - "" '� BACKFILL.SEPTIC TANKS El
-- SEEP.PITSS) [j__G#Ss POOLS ❑
ZI��IVALIDATICIN CK. M,11* CASH
?
CE808 2/70
76.4 64211) APPLICATION FOR PERNkIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING E
JOHN A. LAMBIE, COUNTY ENGINEER BUILDING Olema St .
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCA
OCALITY Temple City
NEAREST
R APPLICANT TO FILL IN -CROSS ST. N. Oak kyeaue
(PRINT OR TYPE ONLY;
LEGAL
DESCRIPTION LOT NO. 4 OWNER John Marshall
rry MAIL
BLOCK 2410 (Tentative ADDR P.O.. Box �
6� 110, OF BLDIGS, 0
517E OF LOT NOW ON LOT CITY Arcadia TEL. NO 2 6-9822
USE OF MAP
Li S 8K PS
BUILDiN DISTRICT NO. GROUP PROCESSEb 3f
Single -Res. (Propose
CONTRACTOR
ADDRESS CONNECTION DATA
/
STATION
C,T-�� TATDEPTH
STA r LIC ANHOLE REFERENCE
L?C E N SE. NO: C LOWER
CIASS/
NO. DESCRIPTION OF WORK FEE
TYPE Or CONNECTION LENGTH FROM wi
Y. CURB P.L. M.L.16 P.L.
E:
PUBLIC SEWER @ $'3":>50SOUSE SEWER CONNECTING TO EPTFCTA-Ni(,SEEPAGE PIT OR P.C.NO.
AND/OR DRAINFIELD $T0.00 CO.IMF.NO. JOB NO.
HQJSE SEWER SON TRUNK PERMIT NO, ROAD PERMIT N
PRIVATE DISPOSAL SYSTEM $3.00
AFFiDAVIlwzw-f-it-1 EASEMINT -R-EC:0-R-D.—INSTW-i�-O-.----CATI: 0
u
WORK TO HOUSE SEWER
-OV ER-FCONNECT ADDITIONAL RLDv OR LO WSE EIPA GE_P'i i:-.6-R-A IN F1 EL,6
EX TN..CESSPOOL.DRYWELL.MANHOLE@ $5,00
ALTER.REPA IR OR ABANDON-W699K HWY.OR ST.WIDENING
SEWER OR DISPOSAL.SYSTEM @ $3.00 i
STATE ENCROACHMENT
Lu
PERMIT 110.
V __to main e C-
��ASTE APPROVAL
Iwith lateral -uo-PI
OWNER'S PERMIT s j oo -----------
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL 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 F USLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS—DAY OF---19—
OWNER OR NEW HOUSE SEWER
OWNERS AGENT—
CONNECT'ADDITIONAL
BUILDING OR WORK
.
I HEREeY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEPPIT(S)ANO/OR DRAINFIELD
AND STATE 'HAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU MB ING AND SEW 6,1 CESSPOOL C3 DRYWELL f- i
ERTI J`I.H�T I A. PROPOIRL)Ir REGISTERED AND/OR ALTER,REPAIR,SEWER OR
I HEREBY
LICENSED
A R Ff Ld�S ANGLJES )tOUN1Y AND STATE OF SEWAGE DISPOSAL SYSTEM
'BY
I E
EN
..I T
CA';F0 A A/r }SAM EG If OWNR OF. AND INTEND TO DISCONNECT FL AND
�;FO 'y if-
RESIDE J� . E A s rN, I R E G
IAL'PROPE TY. ABANDON HOUS U SEWER
SIGNAT14w El
rTT�E IIACKFILL SEPTIC TANKS
OF PERM
2
SEEP,PIT IS) D CESSPOOLS E]
VALIDATION JACK R. ALLEN
CK. W O. CASH SUPERVISING MECHANICAL ENGINEER