HomeMy Public PortalAbout9535 OLEMA ST_Sewer__ 76A6420
3 a E-663 11.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A.LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN, SUPT Or BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
_CROSS ST,
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ADDRESS____
F NO. OF BLDGS.
SIZj,OF LOT —NOW-ON LO-T CITY TEL. NO.
USE OF
_BWLDW�_ DISTRICT No. GROUP MAP
BK P
CONTRACTOR G
CONNECTION DATA
ADDRESS
STATION DEPTH
CITY TEL. NO.
MANHOLE REFERENCE _____YPPER
❑ STATE
REGISTRATION NO. ❑ COUNTY
4fa
DESCRIPTION OF WORK FEE
NO. 1 —c
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OP.
]PITS AND/OR DRAINFIELD $3m
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
EXTN..CESSPOOL,DRYWELL,MANHOLE $2.001 CO. IMP. NO,— JOB NO..�
HOUSE SEWER CONNECTING TO
----PRIVATE DISPOSAL SYSTEM C& $1.00 I TRUNK PERMIT NO. PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEINER (cc $;.00 PERMIT NO.
ALTER, REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR.DISPOSAL SYSTEM WASTE APPROVAL
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
to
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE 1 N SPECTOR'S S I GNAT URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE .U'SUC SEWER.
NEW HOUSE SEWER
SIGNED THIS--DAY CF
CONNECT ADDITIONA
OWNER OR ---5U1,LDIMG OR INORK
OWNERS AGENT—----- SEPTIC TANK,SEEP,PIT(S)
D D R ES S- AN. DOORDRAHNEIEL1.)--------
I HERE," -iAA1 HAVE READ THIS APPLICATION CESSPOOLD DRY19ELLE1
AND STATE THAI.."THF. ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND ,TATE LAWS REGULATING
ALTER,REPAIR,SEWER OR.
PLUMBING AND SE'NERS.
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANIVOR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTIAL PROPERTY. I
BACKFI LL SEPTIC,TANKS I
SIGNATURE SEEP. PITS} Ej CESSPOOLS Lj I—
OF PERMITTEE�.,L.�
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG, INSPECTOR
CK, H.A. CASH
J-