HomeMy Public PortalAbout9434 OLEMA ST_Sewer__ D
S&E-6APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AM SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING t v } -
WM.J. FOX, COUNTY ENGINEER A-„ADDRESS y f � _ I
CASSATT D. GRIFFIN, SUPT Or' BUILDING 1 Y
11 1 LOCALITY •�� �..z.�r
FOR APPLICANT TO FILL IN NEAREST
LEGAL
DESCRIPTION LOT NO. OWfNER
BLOCK TRACT r- 3. MAIL
ADDRESS
, y N0. OF BLDGS.
'SIZ
E OF LOT_ - i;/ NOW ON LOT ...V CITY TEL, NO.
USE OF r. r .
BU.iLDCN�S .J { awell ,..,y .s -
--- _ .._ ---- -- '_ '
DISTR!Z NO. GROUP MAP
BK PG
-CONTRACTOR-t
ADDRESS ”' CONNECTION DATA --
CITY ..- rt TEL. NO. .,;- STATION ate- DEPTH
yyy STATE T MAN,144a.E...,REFERENCi
REGISTRATION NO. �;r r '''. 3 COUNTY - ."�t'' iT E�-`".',] _ _UPOER.:
i'^- 7 TYPE OF CONNECTION LENGTH FROM, d
Nb. DESCRiPTfON OF WORK F E — CURB P.L. M.L.TO P.L.
HOU-SE sE6Nr RCo.i dEc. ,HG TO ff I -
.'. PUBLIC SEWER_ C- 5 3.50
,,I I.�-� �-� 4.,-_ -- --------. .---
H.OGSE SE,E- "ONNECTING TO -
PR VAT£DiSPC)S,,kL SYSTEM 1.00 � ---
CO
NNECT ADDITIONAL BLDG OR
OIP. NO a
0 HOUSE SEWER1.00
O.M � 7 r
-- I ALTER OR DI$FOREPAIR
SALL _ TRUNK PERMIT NO _ _ ROAD PERMIT NO-�'_-��
Y S
tEP 04 DISPOTING SYSTEM _ i On_� � - _
L SCOk NECT AN f RAft ON SEWER 'TAME ENCROACHMENT
Ai{i. ,-)R DISPOSAL SYSTEM 1.00 .
SEP-I 1C TANK, SEEPAGE PIT OROF
P sND OP DRAIN FIELD 2.00 i I IND.USTR`AL
--
CESSPOOL DRYWEI.L- I' j""'-- WASTE APPROVAL- -
S ;TIAL CONDITIONS ONLY 2.o0 ! 4 CHARGES
I ---- ----- -+-
-- ! - CONNECTION CHARGE FEE
—PERMIT S t f OC
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED 1111TH THE: HEREIN NAMED CON-
TRACTOR TO CONNECT .HE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR`S SIGNATURE
TO THE PUBLIC SEWER ---
SiGND THIS--DAY DAY OF h 1 ' " �la � NEW HOUSE SEWER
FEE --
..
OWNER OR j CONNECT ADDITIONAL.
OWNERS AGENT`+ �`">� �..Q- f'2:41' ty _ EUt LDING
'EPTIC TANK SEEP, PITS)
.ADDRESS 4.4 <_:�,-._.4z� n.1dCVOR DRAINFIE,LD
I HERESY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATCONI —CESSPOOL❑ DRYWELL 0
AND STATE THAT THE ABOVE, iS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR -_
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE Of
CALIFORNIA OR THAT I AM THE LEGAL OW]`i Or THE ABOVE AA:NDON r{OUSE SEWER
DESCRIBED RESIDUCNAL IDPERTY. BACKFILL SEPTI„TANKS❑ p
r fir: 5E'cP PI (S) [I CESSPOOLS.( F_
SIGNATURE
OF PERMIT,E� "
WILLIAM J. FOX, CouriTY ENGINEER �TDAT$ON
JUIL 4,
BY •` BY y
DEPUTY
r�. �,. %a..�,;-'7'- DEPUTY
r !`
BY BY
01) DEPUTY `r DEPUTY