HomeMy Public PortalAbout9460 OLEMA ST_Sewer__ DEPAtiC1:MENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS -
FOR AP LIC FILL IN LOCALITY
BUILDING NEAREST
ADDRESS GROSS ST.
LOCALI:1y DISTRICT NO. SERIAL NO. PERMIT NO,
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER'S
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
BK PG
CITY. TEL.NO.
CONTRACTOR
CO.IMP.NO.
ADORES
JOB NO.
CITY �s
'� EL.NO. / TRUNK PERMIT NO.STATE
--
REGISTRATION NO- COUNTY
ROAD PERMIT N0.
LEGAL s
DESCRIPTION LOT NO. f STATE ENCROACHMENT
`,�
BLOCK TRACT f�F` PERMIT N0.
INDUSTRIAL
SIZE OF LOT N0.OF BLOGS. WASTE APPROVAL
NOW ON LOTCHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DE iPTiOIV OF WORK FEE
HOUSE SEWfW-004NECTING TO REIMBURSEMENT FEE
PUBLIC SEWER_ @ $ 3.50 RECEIPT NO. DATE I BY
HORSE SEWER CQNNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 I
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE D SCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS Z. DAY -...•_.......191h .`` NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT .. .- BUILDING OR WORK
ADDRESS------------ z SEPTIC TANK,SEEP.PITS)
.-.-- <t _.--- ......_- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- 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
1 HEREBY CERTIFY THAT t AM PROPERLY R ISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANG B;COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA 0 THAT 1 AM TH AL N•
ER OF THE ABOVE., ESCRI RESIDENTIAL PERT BACKFILL SEPTIC TANKS
SIGNATURE Y , y SEEP.PIT(S)E] CESSPOOLS
,, i
OF PERMITTEE: : .:I ...... .
76AG42D 663 1153