HomeMy Public PortalAbout9450 OLEMA ST_Sewer__ _DEPARTMENT OF COUNTY ENGINES$' ;I SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY . ' PERMIT APPLICATION
COUNTY OF LOS ANGELES _
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO. FILL IN LOCALITY
BUILDING 4. NEAREST
ADDRESS d. L CROSS ST. d jQ
LOCALITY Af DISTRICT NO. SERIAL NO. PERMIT NO.
NNEAREST
EAREST. J J A _--
a 7
Ready for inspection `DAT'E IUE��
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ADDRESS Al Ca' JOB NO.
CITY � + Y -
! ��.JTEEL.NO, � TRUNK PERMIT NO.
REGISTRATION N0. , COUNTY-' ROAD PERMIT NO.'*-,' ��� �'`� � •
LEGAL
DESCRIPTION LOT NO. el STATE ENCROACHMENT
PERMIT NO.
BLOCK 1�""` TRACT INDUSTRIAL
p WASTE APPROVAL
SIZE OF LOT -1?6g0O NO-OF NOW ON LOTS Y CHARGES
USE OF I
BUILDINGS w4
`,.. - �,��` CONNECTION CHARGE F
NO. DESCRIPTION OF WORK ' FEE
,,HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1:00
CONNECT ADDITIONAL BLDG.OR CEPTIO ECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING . • I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00'
DISCONNECT-AND ABANDON SEWER
—AND/OR DISPOSAL SYSTEM 1.06 CONNECTION DATA
SERHO PITS AND%OR DRAT FIELD T OR 2.00
CESSPOOL—DRYWELL STATION `S� DEPTH
SPECIAL CONDITIONS ONLY 2.00 MA FERENCEAol-
�, f PP 11 LOWER
_ TYPE 0 CTION LENGTH FROM
OWNERS PERMIT $ I 00 cu B. _ M.L.TO P.L.
AUTHORIZATION if TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED+-
COAPPROVALS INSPECTORS SIGNATURE DATE
CONTRACTOR TO CONNECT THE ABOVE DESCRIBESCRIBED EXISTING +
DWELLING TO THE PUBLIC SEWER
~"f
SIGNED THIS $e __.— y NEW HOUSE SEWER v
,,.2_DAY OF 19
OWNER OR � -CONNECT ADDITIONAL
OWNERS AGENT r. .r �c�a7.4�__5;i AA i• /��i��' BUILDING OR WORK
�, � ( I r .rr~� SEPTIC TANK.SEEP.PIT(S)
ADDRESS..;+ ___�._.. _ .._�_ Y;_ !` �__, AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS APPLI-4j CESSPOOL 0 DRYWELL _
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE'
TO.COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS-' ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM. PROPERLY REGISTERED.' DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY, ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN.
ER OF THE ABOVE DESCRI ED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE _ EEP.PIT(S)� CESSPOOLS
OF PERMITTE
76A642A 663 7/53