HomeMy Public PortalAbout9479 OLEMA ST_Sewer__ DIEPART131ENT OF COUNTY ENGINEER SEVIER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION'
COUNTY OF LOS ANGELES R U I L D I N G
WILLIAM J. FDX, COUNTY ENGINEER ADDRESS ��
FOR APPLICANT TO FILL IN LOCAL!7=--
BUILDING NEAREST
ADDRESS CROSS ST. ,
LOCALITY DISTRICT NO. SERIAL NO. I PERMIT NO. C
NEAREST
CROSS ST.
t
OWNER RECEIVED BY` I Ready for Inspection DATE/I�SSUED
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CITY .,' >> TELAO. - G '
CONTRACTOR` l CO.IMP.NO. ]] 5
ADDRESS JOB.NO. - --
CITY TELAO. 4,
TRUNK PERMIT NO. '
STATE -
REGISTRATION NO. r COUNTY p,OAD PERMIT N0. Z -5 Z�r
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. .dJ PERMIT NO.
BLOCK TRACT INDUSTRISTE AL
NO.OF BLDG
-�—
SIZE OF LOT NOW ON LOTS
CHARGES
USE OFF� CONNECTIO RGE FEE
BUILDINGS , _
NO. I DESCRIPTION 13F WORK FEE
REIMBURSEMENT FEE
—1 HOUSE SEWER CONNECTING TO r --
PUBLIC SEWER t S 3.50 7 RECEIPT NO. DA I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO NOUSE SEWER 1.00 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM L00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR - 1
PITS AND/OR DRAINFIELD 2.00 STATION :Z DEPTH •;
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 1 MANHOLE REFERENCE
.'� C LOWER;
TYPEOF �NECTION LENGTH FROM
OWNERS PERMIT s 1 00 UFCB" mosaic M.L.TO P.L. �' r
AUTHORIZATION + TOTAL FEE 7-7-7 r
CONTRACTORHAVE
TO CONNECT THE ABOVE DESCRIBED DATE CONTRACTED WITH THE HEREI
SCRIBEDI EXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..................-DAY OF47z €__•_. ' NEW HOUSE SEWER
-.Y 19__.-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT .............
..-_.. BUILDING OR WORK
- - ..-.-....
SEPTIC TANK,SEEP.PIT(S)
ADDRESS---------,...................-...................-.................................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL E]
CATION AND STATE THAT THE ABOVE 18 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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE �
11 SEEP.PIT(S)[:ICESSPOOLS Q
�
OF PERMITTEE...---------—..... (--------.:..........._-.-.I...--•-•-._------
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