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Home My Public Portal About4961 LOMA AVE_Sewer__ 0-63 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCAL TY 10 NEAREST FOR APPLICANT TO, FILL IN CROSS ST z 01 LEGAL DESCRIPTION LOT N ��(` OWNER MAIL BLOCK TRACT ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROU MAP PROCESSED BY BK PG CONTRACTOR �/ - ADDRESS / ]�Y COECTION D TA CITY TEL NO �ll //IONTH SMANHOLE REFERENCE REGISTRATION NO a �17 ❑ CLOWER NO DESCRIPTION OF WORK FEE YpE OF ON C 1�0 LENGTHROM HOUSE SEWER CONNECTING TO B M L TO L PUBLIC SEWER @ $5 00 } SEPTIC TANK SEEPAGE PIT OR // P C NO �- CO IMP NO ,/(f JOB NO Q PEPTIC @ $1000 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO A $300 •/ /� PRIVATE DISPOSAL SYSTEM @ $3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVES I CASEMENTECORD INS R NO DATE s O WORK TO HOUSE SEWER $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN,CESSPOOL,DRYWELL,MA N HOLE 0 $5 00 d. HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE to SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT Z PERMIT NO INDUSTRIAL } WASTE APPROVAL CHARGES Ommills PERMIT $ 2 00 AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR PTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE UBLIC SEWER DATE INSPECTOR'S 61GN RE SIGNED THIS DAY OF 19_ 41 M OWNER OR NEW HOUSE SEWER _p OWNERS AGENT CONNECT ADDITIONAL j BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S)AND/OR IT(S)AND/OR DRAINFIE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWEROR. LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE �VE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PITS) [I CESSPOOLS ❑ ALIDATION ROBERT WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH Li%o 6 329G" [AAR a 10 D 7.00- Z .00MZ 0-ti3 76A642D y APPLICATION FOR PERMIT tiA642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't o4 Building IOCAI�TY NEAREST FOR APPLICANT TO FILL IN CROSS BT LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS VNO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF I BUILDINGS DISTRICT NO GROU MAP PROCESSED BY �{ 08 BK s- PG CONTRALTO ADDRESS 3� CONNECTION DATA TEL NO l7d S AT/-N DEPTH CITY mm77•�/ J STATE MANHOLE REFERENCE REGISTRATION NO COUNTY ., LOWER NO DESCRIPTION OF WORK FEE FACTION LENGTH FOM HOUSE SEWER CONNECTING TO P L M L TO P PUBLIC SEWER @ 55 00 a. SEPTIC TANK,SEEPAGE PIT OR P C NO NO O JOB PITS AND/OR DRAINFIELD � SIO 00 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO �j PRIVATE DISPOSAL SYSTEM @ S3 00 \.J ^ CONNECT ADDITIONAL BLDG OR AFFIDAVIT wA1VEM E�5[MiN RECORD INSTR NO DATE H WORK TO HOUSE SEWER $300 -3 0_7 3 1J, OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN,CE SSPOOL,DRYWELL MANHOLE @ $5 00 a ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h SEW OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT z PERMIT,NO INDUSTRIAL WASTE APPROVAL CHARGE OWNERS PERMIT s AUTHORIZATION TOTAL FEE D✓] CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL IOPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH Lrl�o 6 3 3 0 MM 9 1 1 D 2 5.0 0-