HomeMy Public PortalAbout9466 OLEMA ST_Sewer__ 76AF APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
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County of Los Angeles BUILDING
ADDRFSS - �"
JOHN A. L.AMBIE, COUNTY ENGINEER
?� C:ASSATT D. GRIFFIN, SUPT OR BUILDING LOCALITY
...NEAREST . -FOR APPLICANT TO FILL IN CROSS T. =` a
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ION LCT NO. — OWNER
--- �rNAIL.-.... TRACT . `� yADDRF5—� �¢
NC.Or' BLDGS. CITY ' -��. '... 7EL. NO.OT NOW`ON LOT ex----._. i 5 ' .t.-v ' ;jy ►„cyr. +y.+ 6PSTRlC'i' N0. iGRGl1P j MAP
BOR- -/ -
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ADDRESS -.� _-.,€-_ _ -.�"�-. '`�.' '- ------ ----- _---- -- ----
CONNECTION DATA
e b- STATION i :�- � f- DEPTH ;�:;•
CITY ^,�. .:. TEL. N
----�.. --=- ------- MANHOLE REFERENCE _STATE
---- LOWER:.-__ -
REGISTRATION NO. COUNTY .
NG. DESCRIPTION OF WORK FEE .--._. _,-----------------------------.�_-___.
TYPE OF u+NtCTtON LENGTH FROM
HOUSE SEWER CONNECTING TO Y- r CURB P.L. M.L. TO P.L.
PUBLIC SEWER @_$3_SJ -- --- --.-- .-----•--------- �--�---------
SEPTIC TANK SEEPAGE PIT OR
PITS AND OR DRAINFIELD -_---------
OVER€LOW SEEPAGE PIT, DRAINFIELD P C. N.O.
r EXTN_,C_ESSPO_OL,D 14ELL,MAiHOLE (c- $2_00 --C- [MP,.NO. #
- JOB NO.
----- ------------ ------
----
HOUSE SEWER CONNECTING TU----_-- I -
F
PRIVATE DISPOSAL SYSTEM--__--__@ $1.00. _ I TRUNK PERMIT NO.-----_._._,ROAD PERMIT,N0._ -, -
' CONNECT ADDITIONAL BLDG.ORSTATE ENCROACHMENT
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WORK TO HOUSE _EVIER _ r' PERMIT N0.
c +
ALTER,REPAIR.OR ABANDON HO-USE _-
i
SEWER OR DISPOSALSYSTEM fa: $i.00 ` INDUSTRIAL
I- .---- --.- _ -_- _ --- ._-. WASTE APPROVAL
j CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE. AT THIS DATE A-'CONTRACT WITH THE HEREIN NAMFD CON- _______ TE DA11 NSPECTOR a51GNATURE
APPROVALS _
TRACTOR T0. CONNECT THE ABOVE DESCRIBED EXISTING DWELLING (TO THE PUBLIC SEWER. _ NEW HOUSE SEWER
SIGNED THIS *-' DAY;OF _�. i9-°�'�
^�--� CONNECT ADDITIONAL
OWNER OR j- .•e7 „ " BUILDING OR WORK _
OWNERS AGEN T ' 6 .----- --..--
"�"l"`"°' ! `"`-� SEPTIC TANK,SEEP PITiS) - - --- --
(�DDREoS '� �'- '-� P -� AN010R DRAiNFIFLD
I HERLBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CE,SSPOOLE] DRYWELLCI
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING1 -
ALT£R REPAIR,SEWER OR. - f
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY ISTERED AND/OR - ----
LICENSED AS REQUIRED BY LOS ANGELES NTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT_I AM THE L4EGAL WNER OF ' -E ABOVE ABANDON14OUSESEWER
DESCRIBED RESIDLNTI. ' PROPERTY BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) Ej CESSPOOLS
SIGNATURE .
OF PERMITTE£i"'
i
fOHN A. LA[/IBiE, C&ONTY ENGINEER VALIDATION__^-._ ROBERT A.WOOD, CHIEF PLBG, INSPECTOR
CK. N.0, �CASR
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