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Home My Public Portal About4964 LOMA AVE_Sewer__ 76A 642D - CE808 - 9/73 APPU'` ATOON FOR PERMOT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL. �f DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _`_�,/ v1 ADDRESS 3J (i-0 y�(� A LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER A hV{'�Lr r C) I _/J / MAIL BLOCK TRACT IyJ /3 (r7 a - / 3 ADDRESS !Y Ave ,ay .'] NO OF BLDG 6 t _ [' SIZE OF LOT .J NOW ON LOT CITY ' TEL NO USE OF BUILDINGS G+v-' DIS TRICT NO GROUP BK MAP PG P OCES D BY CONTRACTOR ;L.4 ADDRESS 360 &Uf)a& ( ` CONNECTION DATA CITY8 TEL NO STATION DEPTH STATED 5 J�%: LIC �J MANHOLE REFERENCE UPPER LICENSE NO, J � GLASS'�f� G LOWER NO I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TOPIL PUBLIC SEWER 0 $7 00 G NO SEPTIC TANK SEEPAGE PIT OR JOB NO PITS AND/OR DRAINFIELD @ $1000 CO IMP NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM ! $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVES I EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER ! $300 d OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL $S 00 U ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING I= SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT C:) MANHOLE $7.00 PERMIT NO W INDUSTRIAL N ^=✓`'-'' '� G `�i(/'LCr WASTE APPROVAL � CHARGES R'S PERMIT a CONNECTION CHARGE FEE ' AUTHORIZATION I TOTAL FEE / 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS _ TO THE PUBLIC S W R� JDATE INSPECTOR'S SIGNATURE SIGNED THIS DA OF /v C 16 � �z OWNER OR .� NEW HOUSE SEWER OWNERS A NT CONNECT ADDITIONAL ADDRES / n ��r/v �L�}�'/✓ r C� BUILDING OR WORK SEPTIC TANK SEEP,PIT(S) [RE ER BY ACKNOWLEDGE THAT 1 HA E READ THIS APPLICATION AND/OR DRAINFIELD STA E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AL COUNTY ORDINANCES AND STATE LAWS REGULATINGBING AND SEWERS CESSPOOL ❑ DRYWELLEREBY ERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR NSED AS FOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM FCRNIA OR (gT I AM THE LEGAL OWNER OF AND INTEND TODISCONNECT PLUG AND DE IN THE; E DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER ATURE t ❑PER MYfTE BACKFILL SEPTIC TANKS �/ T� SEEP PITS) DOLS ❑ V LEDATION CK. 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CASH 0 1 9 JB 15 1 0 B. ! 1 76A 642D-CESOB A-7/76 APP I CATIOA " FOR PERM OT -SEWER—SEWAGE DISPOSA EWER—SEWAGEDISPOSAL COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOIL APPLICANT TO FILL Ild DISTRICT NO GROUP MAP PR CES BY / �� CO IMP NO JOB NO L GALTRUNK PERMIT NO ROAD PERMIT NO DESCRIPTION LOT NO . / AFFIDAVIT wAlv[[ [�s[M[MT RECORD INSTR NO DATE BLOCK TRACT NO OF BLDGS SIZE OF�LOT ' ` NOW ON LOT HWY ORST WIDENING }� USE OF STATE ENCROACHMENT BUILDINGS A' �/•.�' '/��L/ PERMIT NO INDUSTRIAL CONTRACTOR &A- f..+,IV A rle,-I �Jl� WASTE APPROVAL ADDRESS j ' xmzgEe CHARGES Y CITY T L N V /J � 40 CONNECTION CHARGE FEE ^ G (i 'STATE LIC �yREIMBURSEMENT FEE O LICENSE NO C/v 2, CLASS i5 ?r NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE W HOUSE SEWER CONNECTING TO PUBLIC SEWER a NEW HOUSE SEWER SEPTIC TANK SEEPAGE PIT OR Z 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 SEWER OR ALTER REPAIR OR ABANDON HOUSE SEWAGE DISPOSAL SYSTEM SEWER OR DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER I BACKFILL SEPTIC TANKS ❑ SEEP PIT IS) ❑ CESSPOOLS ❑ OWNER'S HIssuance Fee s ti AUTHORIZATION TOTAL FEE HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING q, 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 1 AM PROPERLY REGISTERED AND/OR TO THE PUBLIC SEWER //_ ✓eff LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SIGNED THIS 6Ay OF 9_ 'I CALIFORNIA OR 'THAT AM T E LEGAL OlWnR OF, AND INTENP TO % OWNER OR RESIDE IN TE ABOV E RIB REZDTIALRTY '16WNERS AG NT SIGNATURE OF PERMfTTE ATIO M O /SASH, o /� 0 5 2.`-JUN 16 1 0, 0 1 5.0-C) A:.38 76A 6.42D-CE808 A-7/76 A PPLI,P,Q TOON FOR PERM OT i �l1SIEWER—vSYEWAGI!E DIS1PrLO�SU1SALU 11 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN DISTRICT NO I P SK MAP ROCESSED BY 6 08 ( r BUILDING ADDRESS NECTION DATA f /rI / L G` L 7- LEGAL TRUNK PERMIT NO ROAD PERMIT NO DESCRIPTION LOT NO AFFIDAVIT I WAIVII IAIIMINT RECORD INSTR NO ATE BLOCK TRACT �'7 NO OF BLDGS !! SIZE OF LOT NOW ON LOT HWY ORST WIDENING ' USE OF BUILDINGS STATE ENCROACHMENT ' PERMIT NO w ' INDUSTRIAL CONTRACTOR WASTE APPROVAL ADDRESS 'CHARGES O CONNECTION CHARGE FEE V CITY TEL NO STATE LIC REIMBURSEMENT FEE LICENSE NO CLASS NO DESCRIPTION OF WORK' FEE APPROVALS DATE INSPECTOR S SIGNATURE HOUSE SEWER CONNECTING TO a K PUBLIC SEWER a NEW HOUSE SEWER SEPTIC LANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM SEPTIC TANKSEEP,PIT(S) CONNECT ADDITIONAL BLDG OR AND/OR DRAINFIELD WORK TO HOUSE SEWER ' OVERFLOW SEEPAGE PIT DRAINFIELD CESSPOOL Cl 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 ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS Clj SEEP PIT(S) C3CESSPOOLS OWNER'S Issuance Fee s I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AUTHORIZATION TOTAL FEE O' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 1 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 SEWER LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF \SIGNED THIS DAY OF 19_ y CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO OWNER OR RESIDE IN THE ROVE DESCRIBED R IDEN"PROPE r SWNERS AGENT SIGNATURE OF PERMITTEE ALMATIO CK M,0 CASH ' 44 3 JUL 7 !'v ®. 1 4.5 0 a�U CES08 D APPLICA I00 V O O \ Y D MIT ceeoe e.sa COUNTY OF LOS ANGELES 7 SE R—SEWAGE DISPOSAL DEPARTMENT OF COUNTY-ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE" County En eer ADDRESS 4964 7Loma CASSATP D. GRIFFIN, Supt of Building LOCALITY TemityFOR APPLICANT TO FILL IN CROSS ST. SerDrive LEGAL OWNER B1OCChi " DESCRIPTION LOT NO. �T MAIL BLOCK- TRACT -a _ ADDRESS 5 312 1Y. D&lt�a SIZE OF LOT NOW ON LOTS 61TYTemDle Cit AT-79200 TEL NO. USE OF BUILDINGS DISTRICT NO. GROUP I MAP I P CESSED BY - 7 u / BK PG CONTRACTOR John N. Buchanan 5j®(� ADDRESS 13244 E. Ramona Blvd. CONNECTION DATA CITYBaldwin park TEL.NO. ED-74213 STATION DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION NO. 21537 COUNTY LOWER No. DESCRIPTION OF WORK FEE 'HOUSE SEWER CONNECTING TO, , PUBLIC SEWER @ $3.00 1 SEPTIC TANK,SEEPAGE PIT OR TYPE OF NNECTION LENG FROM 3 OO Y. CUB P.L. M. TO P.L. PITS AND/OR DRAINFIELD @ $3 00 ,s OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00HOUSE SEWER CONNECTING C.,NO. PRIVATE DISPOSAL SYSTEM TO @ $1.00 1 OO CO IMP.NO. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER - @ $1 00 ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO INDUSTRIAL _ WASTE APPROVAL CH GES OWNER'S PERMIT Z 00 CONNECTION ARGE FEE AUTHORIZATIONJ TOTAL FEE O REIMBUR MENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS D TE INSPECTOR'S SIG'''NAATURE TO THE PUBLIC SEWER. _ /zw/ ' SIGNED THIS DAY OF 19- NEW HOUSE SEWER !lIGGG,rFlfffv OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP FIT(S) /� J f ADDRESS AND/OR DIRM.NS EL•D ;W-4 / l A"I/" 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - / (!r"•/ '/� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ F WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED REST NTIA ROPERTY. BACKFILLSEPTIC TANKS // SIGNATURE SEEP PIT(S) ElCESSPODL'Sz OF PERMITTE / ®" ALIDATION ROBERT A. WOOD cK. M.o.- CASH SUPERVISING MECHANICAL ENGINEER