Loading...
HomeMy Public PortalAbout9485 OLEMA ST_Sewer__ _ DEPARTBEENT OF COUNTY ENGINEER = iSEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF IM ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING z ;._ ADDRESS �' FOR APPLICANT.TO FILL IN LOCALITY ' BUILDING NEAREST +� ADDRESS �J�fj�['�/J�'J i , CROSS ST. LOCALITY' » � C /�./ DISTRICT NO. Ready for Inspection PERMIT NO. c NEAREST CROSS ST...._�. ,- RECEIVED BY DATE �j 1jUED BY •DAT�Es OWNER��IMAIL �'y � jiV"ll 5'�i ,N" � �e J ADORESSj&,�'6) 8 i 20NE OCCUPADNCY MAP BK PG CITY TELNO. .3_S CONTRACTO �?r �i �. i`�l � .9 ate. CO.P:NO. `� /fig ✓��j' ADDRE C JOB.N0. ClTY' G9 C TELp:NO. rJG TRUNK PERMIT N0: REGISTRATION NO. tJ_ © G OUNTY` ROAD PERMIT NO. - LEGAL TE ENCROACHMENT DESCRIPTION LOT N0: p T N0. BLOCK TRACT 5-3 3 INDUS AP L OVAL SIZE OF LOT N0:OF BLDG& NOW ON LOT CHARGES �, USE UI DINGS CONNECTION CHARGE F,_ NO.--DESCRIPTION OF WORK_ FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER @'$ 8.50 RECEIPT N0. I DATE BY HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL.SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR 1 EXCEPTION RECORDED _ WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING N0. I DATE I BY _ SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.60 CONNECTION DATA TANK,SEEPAGE PIT OR PITS A PITS AND/OR DRAINFIELD 2.00 STATIONDEPTH CESSPOOL—DRYWELL MANHOLE REFERENCE SPECIAL CONDITIONS ONLY 2.00 /84-1 � LOWE TYPE OCTION LENGTH FROM OWNERS PERMIT Y.: C.UR P.L M.L.To P.L. C i I OO AUTHORIZATION TOTAL FEE L I 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 •�" _ AY OF_sCrCT/�//��19zr' NEW HOUSE SEWER � '�, � 4:221.-r CONNECT ADDITIONAL OWNEROWNES AGEN ' BUILDING OR WORK � /' i SEPTIC TANK.SEEP.PIT(S) � ADDRESS._ Sa °_. ,EE�.!2? L� �.r... AND/OR DRAINFIELD 1 HEREB1f`ACKNOWLEDGE THAT I HAVE READ THIS APPLI-'i CESSPOOL 0 DRYWELL I 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 SEWER& SEWAGE DISPOSAL SYSTEM — I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED' BY LOS ANGELES COUNTY': DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER ER OF THE ABOVE DESIBED lMTIAL ROPE BACKFILL•SEPTICTANKS rl SIGNATURE ! SEEP.PIT(S)[] CESSPOOLS OFPERMITTEE.. J i ' It 76A642D S&E 663. 4/64