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Home My Public Portal About4954 LOMA AVE_Sewer__ 76A 642D-CE808 A-7/76 APPLOCATOON FOR 'PERRfi T _SEWER—SIEWAGE DISPOSAL COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN DISTRICT NO GROUP BK MAP P CE S D BY 51 NO 0ADDRESS / V CONNECTION DATA LOCALITY �[ ,r NEARESCROSS T �Y/ STATION DEPTH (91 UPPER MANHOLE REFERENCE - �� LOWER 1 OWNER H. TYPE OF CONNECTION LENGTH FROM MAIL , } ® n �w Y CURB P L M L TO P L • ADDRESS (... (.E. G pP C NO K CITY Q {–/ •TEL NO CO IMP NO JOB NO LEGAL /y n TRUNK PERMIT NO ROAD PERMIT NO ,+{ DESCRIPTION LOT NO �i(J� "`,�.L.� AFFIDAVIT I wAlv[R I [Ascr[rT RECORD INSTR NO DATE BLOCK TRACT ,�Lv ��yy NO OF BLDGS SIZE OF LOT ,�O ,,3(/ NOW ON LOT HWY OR ST WIDENING USE OF STATE ENCROACHMENT BUILDINGS PERMIT NO INDUSTRIAL CONTRACTOR /V[L/Q E/y LJ JG11 /V�T �• WASTE APPROVAL M ADDRESS !O /VCHARGES fl�l CHARGES } / A /�j� 7 CONNECTION CHARGE FEE CITY �f.�/�/ &4TEL NO !!�3 STATE �h /t"� 7 LIC 7� REIMBURSEMENT FEE C LICENSE NO GLASS V I� NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE HOUSE SEWER CONNECTING TO d PUBLIC SEWER @ ' y SEPTIC TANK SEEPAGE PIT OR NEW HOUSE SEWER �/^ PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK S e- PRIVATE DISPOSAL SYSTEM SEPTIC TANK SEEP,PIT(S) CONNECT ADDITIONAL BLDG OR AND/OR DRAINFIELD WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT DRAINFIELD CESSPOOL ❑ DRYWELL ❑ EXTN CESSPOOL DRYWELL MANHOLE ALTER REPAIR OR ABANDON HOUSE ALTER REPAIR SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS ❑ SEEP PIT(S) ❑ CESSPOOLS ❑ OWNER"S Issuance Fee s AUTHORIZATION TOTAL FEE ` I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION s . AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING i I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. PLUMBING AND SEWERS TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR . TO THE PUBLIC SE _ JY LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SIGNED THIS DAY OF �/ 19 CALIFORNIA OR THAT I AM THE LEGAL ER OF, AND IN TO OWNER OR RESIDE IN THE AB� ESC ED R ID TIAL P +'GWNERS AGENT / ; SIGNATURE N/ '—O t �f OF PERMITTEE j ADDRESS LIDATIO M 0 CASH 0 4 1-C,-ItI1a iu A. ��, u 1 5.0 U m ; 76A 612D-CE808 A-7/76 APPll OC A TOON FOR PERMOT SEWER-SEWAGE DISPOSAL IILJII COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN DISTRICT NO GROUP BK MAP PG CESSED BY //'' • ADDRESS ! 4om Me- �v ✓ I �� , l LOCALITY - I CONNECTION DATA r � NEARESTSP�Pe�U pe ' STATION _`-../ c)� DEPTH CROSS ST V f/rCJ'-r (/� (N�pp MANHOLE REFERENCE / 72.3 p! LOWER OWNER I / /L` TYPE OF CONNECTION! LENGTH FROM MAIL r•. - / jl�, Y CURB p ML TOP L ' ADDRESS i✓� /V� ;. J C NO CITY V� G 6f •TEL NO ��.J�' D '� CO IMP NO OB NO/ LEGAL - �,• �O� �� TRUNK PERMIT NO ROAD PERMIT NO DESCRIPTION LOT N Q� O 7I AFFIDAVIT wA111. !AS[...T ` RECORD INSTR-NO - 'DATE • BLOCK TRACT NO OF BLDS SIZE OF LOT NOW ON LOG HWY OR ST WIDENING USE OFIIO/�1 Cr STATE ENCROACHMENT BUILDINGS /// PERMIT NO b/j//I OII�/�/L INDUSTRIAL - iY CONTRACTOR c WASTE APPROVAL a ADDRESS CHARGES r CONNECTION CHARGE FEE '- CITY TEL NO STATE - LIC REIMBURSEMENT FEE LICENSE NO CLASS NO DESCRIPTION OF WORK FEE APPROVALS - DATE INSP,�SXOR,'S SIGiNATURE HOUSE SEWER CONNECTING TO /' L PUBLIC SEWER U „J� �- N SEPTIC TANK SEEPAGE PIT OR NEW HOUSE SEWER yy PITS AND/OR DRAINFIELD CONNECT ADDITIONAL = HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM SEPTIC TANK SEEP,PIT(S) CONNECT ADDITIONAL BLDG OR AND/OR DRAINFIELD WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT DRAINFIELD CESSPOOL ❑ DRYWELL ❑ EXTN CESSPOOL DRYWELL MANHOLE ALTER REPAIR OR ABANDON HOUSE ALTER REPAIR SEWER OR SEWER OR DISPOSAL SYSTEM Q SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDOWHOUSE SEWER BACKFILL SEPTIC TANKS,❑ SEEP PIT(S) ❑ CESSPOOLS ❑ fi OWNER"S Issuance Fee s � r, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION p AUTHORIZATION TOTAL FEE - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING�t 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- I PLUMBING AND SEWERS TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR TO THE PUBLIC SEWER LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SIGNED THIS DAY OF )g_ CALIFORNIA OR THAT i AM THE LEGAL OWNER OF AND INTEND TO OWNER OR RESIDE IN THE ABOVE DE RIBED RESIDENT I L PROPERTY +6WNERS AGENT ) SIGNATURE OF PERMTTTEE LIDATIO CX, M,D CASH 442'c--JUL 7i " � 1 5.v0 � DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OFLOS ANGELES I BUILDING ADC �•�� 1 WILLIAM J. FOX."COUNTY ENGINEER ! DRESS FOR APPLICANT TO FILL LOCALITY�r , BUILDING NEAREST ��rim ADDRESS � w a CROSS 3T. �1"�"' LOCALITY DISTRICT NO SERIAL N0. QPE//RMIT NO. NEAREST ,SG)g_S CROSS ST. - R CEIVED BY Ready for Inspection DAT ISSUE r OWNER G ;4a " 1�� MAILUSE ZONE OCCUPANCY BK MA PG -ADDRESS �' � - CITY '- TE4N a ,/ CONTRACTOR IK- ,{ CO.IMP.NO. ADDRESS7, JOB.N0. CITY �({ � TEL.NO. 6 TRUNK PERMIT NO. r/0 STATE REGISTRATION N0. COUNTY ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. PERMIT NO. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLDGS. NOW ON LOT CHARGES USE BUILDINGS CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE i HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO' DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL-DRYWELL N SPECIAL CONDITIONS ONLY 200 MANHOLEUPPER LOWER LOWER * TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT ; I I UO Y. CURB P.L. M.L TO P L. AUTHORIZATION TOTAL FEE p0 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-.-..-.-..DAY OF___ .-. _.. Iq-_.• NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT.........................._. BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS....................._.--...-.........._----.-._.._.._-._...-......_.._..--_. AND/011 DRAINf.IELD I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLI. CESSPOOL DRYWELL E]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE f/ 2 TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND PLUG AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDEN IAL PRQPERTY. BACKFILL SEPTIC TANKS E] SIGNATURE �1/j 1"��(//J- SEEP.PIT(S)Ej CESSPOOLS OF PERMITTEE 76A642A 663 7/53