HomeMy Public PortalAbout9517 OLEMA ST_Sewer__ 76A
6-663 i9�55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer _
County of Los Angeles BUILDING
JOHN A. L.AMBIE,COUNTY ENGINEER ADDRESS �`�������✓��sfy� ✓ s '6��,
P7 CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
LEGAL FOR APPLICANT TO FILL IN doss s.
DESCRIPTIONL07 N0. OWNER �✓ ✓��'�ra j
MAIL
BLOCK TRACT - ADDR.ESS r...�
NO. OF BLDGS. CITY - TEL. NO.
SIZE OF LOT _ NOW ON LOT
USE OF
BUILDINGS '.a,`� p * :,,,-� �9' GROUP
Jr DISTRICT NO. .: MAP
BK PG.
CONTRACTOR - - .,,.,,J �..�''�• ,.•s�'
CBNINECTIONI DATA "'= a
ADDRESS5 Y' 1� .�^'•' ----- ---
, _STATION' '� DEPTH3
CITY s,°`ff �# r; "-TEL. NO.,�'-�!",y,� ✓ ✓'%` ,y a°rr"�_
E REFERENCE
REGISTRATION N0, CI COUNTY
NO .-DESCRIPTION OF WORK -- FEE 51! TYPE OF+CWCTION� LENM.LGTH FRP,LOM
g 1 HOUSE SEWER CONNECTING TO
PUBLiC SEWER @ $3. 0 '. -- j --
SEPTIC TANK,SEEPAGE PIT OR
-__- PITS AND/OR DRAiNFIE.LD
OVERFLOW SEEPAGE PIT DR9 NFIEL.Dt P. C. NO.
CO. 1MPNO
. . JO$N0.
EXTN.,CESSPOOL,4RYQUELL �(ANJiOI.f @ $2.00{ .0 , _.. —_._—_-
-I HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM L, $_1.00 TRUNK PERMIT N0._ ROAD PER_ _-_NO.
_
CONNECT ADDITIONAL BLDG.OR STATT ACHMENT.
WORK TO HOUSE SEWER Oil $__08 PERMIT NO. - -
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM !�; I pp 'NDUSTRIAL
�+ �_ *ASTE APPROVAL -.
CHARGES
f
_-- ------ --,_ _---- CONNECTION CHARGE FEE
OWNER'S PERMIT
-----� 1---..1 0�--` P..EIMoURSE4lENF FEE-
AUTHORIZATION TOTAL FEE. APPROVALS
DATE NSPECTOR`SSIGNATURE
I HAVE AT THIS DA"I r'. A. CONTRACT W'iTY; THE HEREIN NAMED CON. -----._----- ---------_;-... _._.___--�. ---------_._...-_.--. _
TRACTOR. TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING i
TO THE PUBLIC SFry`R.-- - - NEW HOUSE SEWER
Ar
SIGNED OF_ a " 73'.._^" CONNECT ADDITIONAL
IONAL
OWNER ORbU1L DING OR lORfC
OWNERS SEPTIC TANK,SEEP.,PIT(S) -
ADDRESS. _ ---- - AMU_"OR DRA,I,NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL D DRYWELLI
AND STAIF THA, THE ABOVE IS CORRECT AND AGREE TO COMPLY _..._-_.._-------_--�------_-�------._..—.--
1^r lTn ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR `
PI_UYSiNG AND SEVERS, SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND I
LIrL dSFD AS REDUIRED BY LOS ANGELES COUNTY AND STATE OF
ABANDON HOUSE SEWER
CAL.iFORNIA GR THAT AM THE LEGAL OWNER OF THE ABOVE - - --- {- - - —
DESCR1Ij,I34R.RESJDENTjWL V POPERT:. ',✓"' BACitif ILL SEPTIC TANKS 1:1
SIGNATURE i SEEP PIT .S)_�D CE-Sf�OOL ----
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOL?, CHIEF PLBG. INSPECTOR
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