HomeMy Public PortalAbout9471 OLEMA ST_Sewer__ '6A 642D -CE808 -10-71 APPLICATION FOR ; E..RMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING/
ADDRESS (oj+
LOCALITY C
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.LEGAL
I DESCRIPTION LOT NO. 1;2OWNER
MAIL
BLOCK TRACT % ADDRESS
NO. OF BLDGS.
SIZE OF LO7 � NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICTNO. CROUP MAP PR SSED BY
_ frrBN'��1 p 9
CONTRACTOR Y04rllV G
ADDRESS Z % /f j J �J {� COLNNECnO'N- DATA
CITY ��� EL. NO. a( -a?39,4- STATION SCJ DEPTH
STATE ` LL �J� +� MANHOLE REFERENCE
LICENSE_NO, C�5_5 7 Z' GLA55 V '7 ,
NO. 1 DESCRIPTION OF. WORK FEE TYPE OF CONNECTIOh LENGTH FROM
HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. _3 V//^(�
PUBLIC SEWER 0 $7.00
P.C.NO.
SEPTIC TANK,SEEPAGE PIT OR CO.I.P.NO. i'J'/� JOB NO.
PITS AND/OR DRAINFIELD 0 $10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. p},
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVES EASEMENT RECORD,INSTR.NO. DATE O
WORK TO HOUSE SEWER 0 $3.00 3 Q GS' V
OVERFLOW SEEPAGE PIT,.DRAINFIELD Q[
E XT N.,CESSPOOL.DRYWE LL. $5.00 HWM.OR ST.WIDENING O
ALTER,REPAIR OR ABANDON MOUSE
SEWER OR DISPOSAL SYSTEM $3.00 _ STATE ENCROACHMENT
MANHOLE $7.00 PERMIT NO. Lu
d.
INDUSTRIAL N
WASTE APPROVAL Z
OWNERS PERMIT $ 3 00 CHARGES
AUTHORIZATION TOTAL FEE `✓� CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF-_19—
OWNER
F19_OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS A GLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE L AL OW ER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIB REST NTIAL P OPERTY. ABANDON HOUSE SEWER
SIGNATURE
OFSEPTIC TANKS ❑
OF PERMITTEE SEEP.PITS) [41 -CESSPOOLS ❑
VALIDATION CK. J M,O, CASH
f
4 55r 6.0oA
>6A6420
��868 59..,58 APPLICATION FOR PERMIT
S tk
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING
ADDRESS ,r
.JOI-{I�I A. L..A$Vi,C31E. CCTUhdT'Y E�NGINEE.R "
v'7 iC.ASSAT"P C7.GRiFF[N, aUP'T C9F BUILD iNG LOCALITY
NEAREST
FOIL APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT N0. OWNER
MAIL
BLOCK 7 R IGT ADDRESS
- NO.OF BLDGS, J
++ CITY TFL. NO.
SIZE OF Lt,[�; ,�. � � NOW ON LUT
USE OF
BUILDINGS y,s�. ,,. DISTRICT N0. GR I teIAP
-M-�- RK PG
CONTRACTOR 64--—
CONNECTION DATA
A r:)a_Es.r ---
y-� STATION �,. .a�-. DEPTHJ,r,9`
CITY T %' l TEL NO. --- �LL UPPER':
h§ANHOLE REFERENCE
L STATE .,-
RE-ISTRATTON NO, COUNTY �s
No. DESCRIPTION OF WORK FEE — TYPE OF CONNECTION -� LENGTH FROM -----
-- - - ---
- j
HOUSE SWER CONNECTING TO
-..._� 4VcR _ S '-C-U-q Fw,. M,L.TO P.L.
PUBLIC 5 .-
SEPIC TANK,SEEPAGE PIT OR -
PITS ANO/GR DRrAINFIE,Ill (Cy 3..00 --
-�OVERFLOW SEEPAGE PIT DRAINFE.LDC N0. -
N CESSPOOL,DRYWELL,MANHOLF (a $?,_00 _JuB NO.._-,
! HOUSE SEWER CONNECTING TO ! ! -
PRIVATE DI POSAL S`STEM ("g $1.0,0 TRUNK PERMIT NO ROAD PERM IT NO.,>:
CSNrvECT JGiIONAL LLDf C'42 STATE FNCROAChM ENf
WORK TO HO I.,SE SF'fER 1,0 j _PERMIT NO.
—
ALTER,--REPn R OR ABANDON HOUSE jIND
SEWER ORD 3POSAL-SYSTEM !� $a,0) j - WAST APP .
—._ .. -..� -_.__ WASTE APPROVAL
CHARCES
I j �
-- - _-- -- -_--.'- ------_JI--.___-j_—_-- CONNECTION CHARGE. FEEOWNER'S PERMIT
_
- R£[ lBURSEMEYT FEE -------
AUTHORIZATION -TOTAL FEE --� Z_/ p �f 7t
I HAVE, AT ,THFS DATE A CONTRACT WITH THE HEREIN GFAMED C{3N- APPROVALS � DAIr �'TSPEC OR"-[CNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING — --- —� -
TO THE P.UBL;C yuVI.R. NEW HOUSE SEWER
1 —'------- '- — --
SIGNED T Ii1S _.—._.DAY Oi ti � ��, � —19 y coNNECT ADDIT1-0N,AL �
OWNER OR. BUILDING OR'1ORK
OWNERS AGENT _.- — '
'-a'=� SEPTIC TANK,SEEP, PIT(S)
ADCAE,S___--.' ANG/Oh Dr:AINFIELD - _
] REP+ ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL��] DRY+HELL L1. -
r"D T T T T F� .,BOLE IS CORRECTLAND AGREE TC COMPLY —.-__
02 7'r;' ALL COUNTY ORDINANCES AND 57A-iE LAWS REGULATING ALTER REPAIR SEWER OR `I,
ri,.J'+ Nt iI;D W l ', SEWAGE DISPOSAL SYSTEM
I HERE Y Eq THAT a AN PROPERLY REGISTERED AND/OR DISCONNECT PLUGAND — -� — —
LICENSED 1 REQUIRED F'l LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER L[I A [HAT.- ' A-N THF F:Gk,L OWNEi OF THE ABOVE -- -- -- -- — -- —'--- ----
L'E-`GRIBED RE IDLNTIA.. PRCPEATf r - BACK—FILL SEPTIC TANKS7 - _
SIGNATURE SEER PIT(S) Q CESSPOOLS
OF PERMITTE --
JOI'-fIN A. LAMSIL, COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLSG. INSPECTOR
CCS. N. G. CASH