HomeMy Public PortalAbout9478 OLEMA ST_Sewer__ 808 20
16A 64Z[)/7APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER J
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FNEAREST
R AP12LICANT TO FILL IN CROSS ST.
(PRINT OR TYPE ONLY)
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DESCRIPTION LOT NO_ OWNER X�4
BUILDING
MAIL
BLOCK TRA, ADDRESS
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS
GLSTRIC7 NO. GROUP CLASS 13 1" MAP PROCESSED) BY
P,
A.
CONTRACTOR
ADDRESS S%f=k- COIYPYECPTON
CITY STATION 24DEPTH
TEL. NO.
STATE LICMANHOLE RSFERE14CE c V.
LICENSE NO. CLASS LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF 4G
� - _
FROM
M
HOUSE Y tP.L.
PUBLIC SEWER
SEPI 1 c r A N K.SE 6p�_A6_E:_PlFT OR ;L 7`7 P c No.
PITS AND/OR DRAINFIELD $10.00 A-
Imp-NO, 08 NO.
1HOI"SE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
_11RIIATE DISPOSAL SYSTEM $3.00 5 1 ' .. I
CONNECT nDDI IONAI BLDG.OR _A_FFjo_,wvnf T lW0.-1 Wa7_xW, —INSTR,NO. DATE 0
,�,o,RRK r O.H o u s E SF w E R -@ $7.00
OVERFLOW -
LOWSEEPAGE PIT,DRAINFIELD I
--,—I_EXT_N..!CESSLOOL.DRYWELL.MANHOLE* 55.00
ALTER.R1:PA111 OR A�BA_4_1545N HOUSE H W Y.OR ST.WIDENING 0
SEWER OR DISPOSAL SYSTFMp 00 1-
STATE ENCROACHMENT u
PERMIT NO. Lu
INDUSTRIAL
_Nj,�.TE APPROVALz
CHARGES
OWNER'S PERmiT 00 CONNECTION CHARGE FEE
C,
AUTHOMATION TOTAL FEE Ae) "5, __ --- ____
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
"R ACTOR T NNECT THE ABOVE DESCR)BFD EXISTING DWELLIN2
0 C'')
TO THE PUBLIC SE'dJ,ER. APPROVALS I DATE iNSPECTOR'SS;GNATURE
SIGNED THIS -._ DAY OF19
OWNER ORNEW HOUSE SEWER
OWNERS AGENT- �llv
CONNECT ADDITIONAL
BUILDING OR WORK
_ADDR!_S
jl�_ SEPTIC TANK,SEEP,PIT(5)
HEREBY ACKNOW THAT I HAVE READ THIS APPLICATION AND/OR DRAINFiELD
I TC
AND STATE: THAT THE 15 CORRECT AND AGRE� TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMB
NG AND SEWERS. CESSPOOL DRYWELL
-_ —-_ __-__...__...—.-_—.-..—._-{---_.. i
_ -EW-__... _ r________
HEREBY RESY CERTIFY THAT - AM PROPERLY REGISTERED AND/OR A!TER,REPAIR.SEWER OR
LI C C"4$E0 AS RFOWREDBy LOS ANGLESCOUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
.
('ALIFORNIA OR. THAT,1-AM THE LEJ&AL_Z.WNER OF, AND INTEND TO
I; T PLUG AND
RESIDE !N� IRE RS41DIINTIAL PROPERTY,
ABANDON HOU SE SEWER
51,0NATURE BACKFILL SEPTIC TANKS ❑
F,P SEEP,PIT 15 T�A
4 �,t
CESSPOO G
j
VALIDATION JACK'7R. ALLEN
CK. M.0 CASH 4JPERVISING MECHANICAL ENGINEER
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Jwk D 1 0.0 0-
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