HomeMy Public PortalAbout9463 OLEMA ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 A
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 NEAREST
ADDRESS_._.,. CROSS ST.
LOCALITY i DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST — -- - A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE.ISSUED
OWNER
MAIL USE ZONE OCCUPANCY
ADDRESS ! BK MAPPG
CITY TEL.NO. i
CONTRACTOR !!!
----.__:�._------------- CO.I M P.N 0.
ADDRESS
---- _,� - JOB.NO.
CITY '^— EL-NOS TRUNK PERMIT NO.
❑ STATE —
REGISTRATION NO. 1 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. f
NOW ON LOT CHARGES
USE OF -
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE v REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER $ 3.50 I� _ RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 I
ALTER OR REPAIR NO- I DATE IBY-
SEWER OR DISPOSAL SYSTEM_ 1.00
DISCON_ NEC7 AMD ABANDON SEWER
AMD/OR DISPOSAL SYSTEM_ 1.00 I CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—DRYIVELL
_i SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L•...r„ M.L.TO P.L.
OWNERS PERMIT ; � I 00
AUTHORIZATION TOTAL FEE I -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF_..................................._..14-.---- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........._................................................................... BUILDING OR WORK
—
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-----..-..--•------.-- ... - .... ......------............... AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND ++
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE SEEP.PIT(S)o CESSPOOLS
OF PERMITTEE--- - y.-- r-..• _}_L� _ x.,,-•-.`-
76A642D 663 1/53