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HomeMy Public PortalAbout9472 OLEMA ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER, SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION ^OUNTY OF LOS ANGELES WILLbiM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING +, .- NE DRESS AREST ADs +fir 3 r CROSS SL LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A S CROSS ST RECEIVED BY � Ready for Inspection DATE ISSUED OWNER a.-" MAIL ADDRESS USE ZONE OCCUPANCY MAP BK PG CITY. fit' TEL.NOY%7 L 6 j CONTRACTOR -- �_ CO.IMP.N0, ADDRESS JOB.N0. CITY TEL.NO. TRUNK PERMIT N0. © STATE REGISTRATION NO. COUNTY ROAD PERMIT NO. LEGAL F STATE ENCROACHMENT DESCRIPTION LOT N0. aJ PERMIT NO. BLOCK TRACT g t INDUSTRIAL i WASTE APPROVAL SIZE OF LOT,,; NO.OF,BLDGS. A '' NOW ON LOT CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO -PUBLICSEWER@ $ 3.50 _" RECEIPT NO. DATE I BY T HOUSE SEWER CONNECTING TO _PRWATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 NO. ( DATE SY ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR I IT AND/OR DRAINFIELD 2.00 I _ STATION DEPTH T. CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE ,- _ LOWER TYPE OF C^`:„ECTION LENGTH FROM _Y. CURB P.„- M.L.TO P.L. OWNERS PERMIT $ I 1 00 AUTHORIZATION 11 TOTAL FEE _ 1 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-4--•�_ _ a'_.....19Xt., NEW HOUSE SEWER OWNER OR 01 1-s_- CONNECT ADDITIONAL OWNERS AGENT ... t �'_:.;e_4 BUILDING OR WORK ADDRESS... ,f ..- SEPTIC TANK,SEEP.PIT(S) � - - --r'.��:�.r�k=�:._................__..- AND/OR DRAIkF1ELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG AND AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S)[] CESSPOOLS OF PERMITTEE-------------- ' ------ ................ 76A642D 663 1/53