HomeMy Public PortalAbout9427 OLEMA ST_Sewer__ 6A„6420 ;CE808-10-71 APPLICAT N FOR PERMIT
COUNTY OF LOS ANGELES SEWE SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY
NEAREST
FOR APPLICANT T _FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. - OWNER
MAIL
BLOCK TRACT / ADDRESS
NO.-OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. N
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED.BY
BK PS
_ $
60NT RACT 'G`" _ �. �+, F Cr" •�i'-�.-�- (I;(,�'Lir,.v
ADDR CONNECTION DATA w _
A2It 4eO ATION DEPTH
E - LIC 444 MANHOLE REFERENCE LOWER
UPPER
LICENSE NO:, CLASS
NIS. DESCRIPTION OF WO FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P..L:
PUBLIC SEWER 0 $7.00
SEPTIC TANK,SEEPAGE PIT OR P.C.
PITS AND/OR DRAINFIELD 510.00 CO.IMP.NO. JOB O.
HOUSE SEWER CON NESTING TO TRUNK PERMIT NO. ROAD Pt'�•RiC7IT NO. — O
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASII i NEC ,T.INSTR.NO. DATE u
WORK TO HOUSE SEWER $3.00 lV ry(p
OVERFLOW SEEPAGE PIT DRAINFIELD _ -^•� - • O�
EXTN CESSPOOL.DRYWELL 0 $5.00OR STWIDE I 0 r O
HWY. .
ALTER,.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 6 $3.00_ W
--- --- STATE ENCROACH NT
MANHOLE 0 $7.00 PERMIT NO.
N
---'--- INDUSTRIAL
WASTE APPROVALj'
('OARGES
.jWNER"S PERMIT � s oo� ` .
A��`- HORIZATION TOTAL FEE �61 r CON NEC710N CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC. SEWER. APPROVALS DATE INS -CTOR'S SIGNATURE
SIGNED THIS DAY OF 19_ - / "-
OWNER OR NEW HOUSE SEWER [
_
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,P'17($)
AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '
WITHALL COUNTY ORDINANCES AND STATE LAWS REGU ATING
PLUMBING AND SEWER CESSPOOL ❑ ORYWELL ❑
I HEREBY CERT T I AM PROPERL REGISTERE AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS Los GLE UNTY,AN STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNI R T T I THE AL O. , A INTEND TO DISCONNECT PLUG AND
�SL`SID THE B -SC D R IDE IA P ABA DON HOUSE SEWER
OF ATUREPER MtfTE s BACFILL SEPTl--..S.
IC S ❑
El.PIT tS) -CES.POOLs ❑
VALIDATIO cK. M.0. CASH
CE808 2/70
76A 64ZO APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER ADD _SS9427 E. Orem St.
COLEMAN W. JENKINS, SUP'T. OF BUILDING
0'
LOCALITY
NEAREST
CRDs S
R APPLICANT TO FILL IN CROS ST. N. Oak Avenue
iPlRiNT OR TYPE ON-Y)
LEGAL
LOT NOOWNER John Marshall
MA
BLOCK TRACT #27410 (tentative ) ADDRESS P.O. Box 1232
12 NO, OFBLDGS.
SIZE OF LOT 6Q x NOW ON
LOT 0 CITY AT TEL. NO. 286-9822
USE 0'
BU-LD,N-,SinRle Familv Res . Pro DIST I.G ED 8'
�R�PC'LASS SK MAP P3 PROCL,%5
CONTRACTOR Ile
o�t�
ADORESCONNECTION DATX
x-Z
STATION DEPTH Icy
T-
STATE C LIC UPPER
1 � MANHOLE REFERENCE
LlcrNSE CLASS
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO CURB P.L., M.L.TO P.L.
U
PBLIC SEWER 00
SEPTIC TAK.SEE PAGE PIT OR 12 P.C.NO.
OR DRAINFIELD
PITS AND/OR CO.IMP.NO- I JOB NO.
HOUSE SEWER CONNECTING 10 TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE
DISPOSAL SYSTEM @ $3.00
CON NEC' ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER FEAi_fmf%T RECORD. INbIH NO, DATE 0
WORK TO HOUSE SEWER $3.0 u
OVERFL _._ ---_� _.__._ __.._._i-- -__..__. 1��1. _
OW SEEPAGE PIT.GRAINFIELD
EXTN_CESSPOOLDRYWELL,MANHOLE@ $5.00
HWY.OR ST.WIDENING
EPAIR OR ABANDON HOUSE
W ORjISP7S;tSYS7E @ $3
STATE ENCROACHMENT
A/41% PERMIT NO. - -
j'-- INDUSTRIAL,
3- WASTE APPROVAL z
OWNER'S PERMIT $
_J 0CHARGES-0 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
IHAV E AT TP415 DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR T CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
HE P
TO T UB L IC S EWER APPROII� DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY/.OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENT _
CONNECT ADDITIONAL
BUILDING OR WORK
ADORES5_�_
SEPTIC TANK,SEEP,PIT(5)
1 .7 REGY Ar'KNOWLEOC.0 THAT I HAVE READ THIS
APPLICATION AND/OR DRAT NFtELD
5 H V I C� 'REE TO COMPLY
AND TATE THAT rHE ABOVE 5 PRECT AND AQ
WIT H AL-L COUNTAN ,, ORDINANCES AND STATE LA WS REG ULATING
PLV
t jMq INER!,,
G CESSPOOL r, 0
I HEREBY CE FY "NEAT I AM PROPERLY,REGISTERED AND/OR ALTER.REPAIR,SEWER OR
L111-1-1111) AS U�E BY LO; -A.NGLEe '�(OUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
'A
A E:_'_ �O
_RN'
ICRNI R H AM T L AL F AND INTEND TO ISCONNECT PL AND
E:5 A VE DE, RIB �ROPERTY_
S
R IN
REV
IN, T ABANDON HOUSE
OLIS UG
ESEWER
0'
SIGN-Ax7
BACKFILL SEPTIC 0 FER E 7- TANKS
SEEP.r CESSPOOLS [j
VAMbA. TION- JACK R. ALLEN
CK. M.1 O. CASH SUPERVISING MECHANICAL ENGINEER