HomeMy Public PortalAbout9525 OLEMA ST_Sewer__ ' 808 10�63
6 EA 6,22 D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL ibll
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION U,U I LIU'I N G
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JOHN A, LAMBIE County EngineerALDREsc °fir ----
WILLIAM A. JENSEk, Sup't of Building ---
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IAIATI_-
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NE-1 REST
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DS ST
FOR APPLICANT TO FILL IN CR,O�SS s_
LEGAL
DESCRIPTION LOT NO.
MA�L.
_BLOCK TRA(�I_ C, ADIIREE35
NO. OF BLDG S.
SIZE OF LOT NOW ON
LOr CITY TEI_ NO.
USE or
BUILLIN GSDISTRICTJGRNO CUP PROCESSED MAP BY
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CONTRACTOR
---------------
ADDRESS
CONNECTION DATA
STATION DEPTH
C I T Y TEL E L N 0.
STATE MANHOLE REFERENCE
REGISTRATIONN COUNTY -LOWER
_NO. FbESCRTPT1_0N_6F TYPE 74NNEC7ION LENGTH FROM
CONNECTING N, Y. P.L. M.L.TO P.L.
PUBLIC SEWER $5.00
C T.
N
PITS AND 1 OR DRAINFIELD @ r,10.00 CO
HO,SS:SEWPR CONNECTING-1 15 TRUNK PERMIT NO. ROAD PERMIT NO.
PRI44rr DI5POSAL SYSTEM 53.00
CONNEC7 I ADDITIONAL BLDG,OR AFIDAV_)T_
F _REAsvmw RECORD.INSTR NO. DATE 0
1r 1 WORK TO HOUSE SEWER ...@._ 3.0/J
9
!LX T N CE-:SSPOOI.,DRYWF.*Lt...MA'4HC)LE 0 S` 0
TER,REPA-114 ii A A_N&&i� WC-S HWY.OR ST.WIDENING
S"WE
OR DISPOSAL SYSTEM $3.00z
STATE E�NCR&A
PVRMIT NO.
INDUSTRIAL
WASTE APPROVAL
s
PERMIT sl 2, 00 CHARGES
OWNI
CONNECTION CHA RGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS 'DATE A CONTRACT WITH THE.- HEREIN NAMED CON- RE-MBURSEMA"N'T FEE
TRACTOR
TO CNEC
ONI E I_
THE' ABOVE DESCRIBED EXISTING DWELjtt.,y
TO I H E P U8 I_IU SETIVCR, AiiI� O ALS DATE _CTOFUSSIGNATUR E
_LINSPF
SIGNED 'THIS---DAY
OWNER OR NEW HOUSE SEWER
OWNERS AGENT___/'�-�
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
T-
SEPTIC TANK,SEEP,PITiS)
HEREBY ACKNOWLEDGE READ I HAVE REATHIS APPLICATION AN10DL
D, R RAiNFIED
A40STA'E 'THAT THE ABOVE 'IS CORRECT AND AGREE: TO COMPLY
L CC)I;ITY ORDINANCES AND STATE LAWS REGULATING
W!I H AL
PLUMBiNa AND 'EWERS.
Rs. CESSPOOL C3 DRYWELL
I H E RESY CERTIFY THAT I At'. PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
'I C COUNTY AND SEWAGE DISPOSAL SYSTEM
_,ENS AS REQUIRED BY LOS ANGLES STATE OF
C ALIFORN111 OR 1)tAT1^M THE LEGAL O"E�-OF, AND INTEND TO DISCONNECT PLUG AND
I,ESiDE iN, THE A8 V
,?0 PE5CRIBEP RES� ENT',#L PROPERTY. ABANDON HOUSE SEWER
RE
S?GNATIJ /
P
OF PLRM AC.111.L..1TI1 TANKS
SEEP,PIT(S) 0 CESSPOOLS [j
TTIEE
VALIDATION ROBERT A. WOOD
Irr
161.O. CAS H SUPERVISING MECHANICAL ENGINEER