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Home My Public Portal About4967 LOMA AVE_Sewer__ 76A642D CE 808(REV 6/781 APPll HCAT�ON FOR P RM O 11 SEWER - SEWAGE DISPOSAL COUNTY OF LOS ANGELES BUILDING ARID SAFETY FOR APPLIC ILL IN DISTRICT NO GROUP MAP 11 PR SSED BY J g 3 BK PG / `_PGQ BUILDING I y 7 / .5 �/ ADDRESS ' 9 CONNECTION DATA LOCALITY , NEAREST STATION DEPTH ' CROSS ST 'UPPER MANHOLE REFERENCE LOWER •OWNE TYPE OF CONNECTION LENGTH FROM MAIL Y CURB P L M L TO P L ADDRESS PC NO YC6-/ _ CO IMP NO JOB NO CITY TEL NO o(C LEGAL TRUNK PERMIT NO ROAD PERMIT NO DESCRIPTION LOT NO AFFIDAVIT I WAIVER I EASEMENT RECORD INSTR NO DATE BLOCK TRACT NO OF BLDGS SIZE OF OT NOW ON LOT HWY OR ST WIDENING USE OF BUILDIN �- 7ATE T ENC NO ROACHMENT MI INDU RIAL CONTRALTO WASTE APPROVAL ADDRESS73 CHARGES CITY TEL NOpL r. O CONNECTION CHARGE FEE , STATE LIC REIMBURSEMENT FEE r LICENSE NO CLASSC ' NO DESCR TION OF WORK FEE APPROVALS '� _ _DATE INSPECTOR S SIGNATURE `Uf HOUSE'SEWER CONNECTING TO i PUBLIC SEWER SEPTIC TANK SEEPAGE PIT OR NEW HOUSE SEWER, - p ITS ANO/OR DRAINFIELD �JJ CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK f/ PRIVATE DISPOSAL SYSTEM COR SEPTIC TANK SEEP PIT(S) CONNECT ADDITIONAL BLDG _ WORK TO HOUSE SEWER AND/OR DRAINFIELD o OVERFLOW SEEPAGE PIT DRAINFIELD CESSPOOL ❑ DRYWELL❑ EXTN CESSPOOL DRY-WELL,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❑ - - Permit SEEP PIT(S)❑ CESSPOOLS❑ OWNER'S s 7 _ AUTFIORIZATIOP! TOTAL FEE / VALIDATION I HAVE AT,THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- JA�Z ry I� - -- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING G ,Ir 5 A TOTHE PUBLI3 C SEWER SIGNEDTHIS DAY OF 19_ - # O O'O O 1.0 OWNER OR OWNERS AGENT •2 O10 1 4.00 ADDRESS q I HERE ;(A- KNOWLEDGE THAT I HAVE READ THIS APPLICATION O O O 1-4 AND STATE HAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -0a.22-79,O�,�^ ^ PLUMBIN AND SEWERS c 9 , _E BY CERTIFY THAT I AM PROPERLY REGISTERED AND/O I LICENS D AS REQUIRED BY LOS ANGELES COUNTY AND STATE CALIF NIA OR THAT I AM THE LEGAL OWNER F,AN INTEND TO E- ,1 SIDE I THE ABOVE DESCRIBED RESI TI PROP RTY ' SIGNA RE• OF PE MI 76A642D• J i �� CE 808(REV 6/781 ®��®��°�� FOR R IT ' os Jj— nSE�i/�aGIE DIJ�"POS eAtlnL`_ �j' - .SEWER.— --i" COUNTY OF LOS ANGELES BUILDING-AND SAFETY DISTRICT NOGROUP t 'MAP, ,1 CESSED,BY, I FOR APPLICA TO FILL IN BK?�' PGa ± BUILDING /�}} / 8, �•74 ADDRESS r(J �!L-. CONNECTION DATA LOCALITY NEAREST STATION' 'a • �' �. DEPTH 354 —_/3 MANHOLE REFERENCE 73 r LOWER OWNER TYPE OF CONNECTION - LENGTH,FROM �. MAIL Y CURB P x" M L TOP L ADDRESS �^ ¢ , - :2 Q J^ �y t` � CO IMP N r JOB NO I CITY TEL NO bf o G / 7 - LEGALTRUNK PERMIT NO• ROAD PERMIT NO - DESCRIPTION LOT'NO L t - / AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE BLOCK TRACT _ "� / L' NO OF BLDGS , SIZE OF LOT NOW ON LOT / H OR ST WIDENING USE OF TATE ENCROACHMENT BUILDING PERMIT NO - I INDUSTRIAL CONTRAC W TE APPROVAL t F CHARGES ADDRESS _ lw CITY TEL NO CONNECTION CHARGE FEE ' STA LIC REIMBURSEMENT FEE LICENSE NO CLAS i NO DESCR PTION OF WORK FEE ' APPROVALS - DATE INSPECTOR S SIGNATURE HOUSE SEWER CONNECTING TO �. PUBLIC SEWER , ' SEPTIC TANK,SEEPAGEPIT.OR _ NEW HOUSE SEWER t PITS AND/,OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK - - PRIVATE DISPOSAL SYSTEM SEPTICTANK SEEP PITIS) - CONNECT ADDITIONAL BLDG OR AND/OR,DRAINFIELD- ¢+ WORKTO HOUSE SEWER - e 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' - -Y j •• V - ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS❑ - •- -+ . t Pefmlt s SEEP PIT(S)❑ CESSPOOLS❑ OWNER'S 'VALIDATION- I AUTIiORIZATN" IO ' TOTAL FEE," ' " i)d r I HAVE AT THIS-DATE A,CONTRACT-WITH THE HEREIN NAMED CON- - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ;03360A TO THE•PUBLIC SEWER - - SIGNED THIS-' DA F - 19- _ '.O 0.0 O•'1,O, ' OWNER OR OWNE RSAG 1 _ _ •., ,,, •, ADD RES i Y O C 1800 7 Ezr I HER EB ACKNOWLEDG HAT I H E RE THIS APPLICATION' O O AND STA THAT THE ABO IS CORRECT A D AGREE TO COMPLY O O O , WITH ALL COUNTY ORDI NCES AND STATE LAWS REGULATING PLUMBI AND SEWERS- '-- - • - - -- --^-^ - I HE BY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O 2 4 r 7 9 LICENS D AS REQUIRED BY LOS ANGELES C NTY AND STATE OF 7 CALIFO NIA OR THAT I AM THE LEGAL O NE F AND INT NO TO RE- 'SIDE IN BOVE"BESC RIBED RES I PROPERTY 1 r SIGNATOR - - OF PERMITTEE ' F V � f�-P ?� r7 s' �� 2/70 76A6A 642D APPLICATION( FOR PERMIT 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAM BI E. COUNTY ENGINEER AU'REss a, P COLEMAN W JENKINS SUP T OF BUILDING LOCALITY 7 ` FOR APPLICANT TO FILL IN NEAREST CROSS 5T (PRINT OR TYPE ONLY) LEGAL ,,ee `�w�E DESCRIPTION LOT NO OWNER 5��• �( O V 0 MAIL ^ BLOCK TRACT ADDRESS Lei NO OF BLDG SIZE OF LOT NOW ON LOT CITY TEL NO USE OF r• BUILDINGS J DISTRICT NO GROUP CLASSBK MAP / PROCESSED By Irep-CONTRACTORfftll Q v' S ! ADDRESS Q X /(j CONNECTION DATA CITY `+TEL NO Sy- 0 7Z� STATION DEPTH LICENSE NO STATE 2 6 / C'L LOWER MANHOLE REFERENCE UPPER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGT ROM HOUSE SEWER CONNECTING TO Y CURB PL M L O P L PUBLIC SEWER @ SS 00 PC O SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD 51000 CO IMP NO J NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d PRIVATE DISPOSAL SYSTEM S300 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER [ASEM[ RECORD INSTR NO DATE V 53 00 OV ERFLO IT RAINFIELD 0 G SSPOOL DRYW LL MANHOLE @ $5 00 O ALTER REPAIR OR ABANDON HOUSE HWY OR ST WID INC 0 SEWER OR DISPOSAL SYSTEM @ S300 STATE ENCR CHMENT W PERMIT N CL INDU IAL h WA EA Z_ OWNERS PERMIT $ 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO TME PUBLIC SEWER DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT - CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION T SEEP PIT(9) AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY 4typLQl3.gflAJ.NE,I,E,�Q 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 CE � LINSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DIS POSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGA OWNER OF AND INTEND TO DISCONNECT PLUG AND { f /� RESIDE IN THE ABOVE DESCRIB D SIDENTIAL PROPERTY ABANDON HOUSE SEWER I( SIGNATURE BACKFILL SEPTIC TANKS El SEEPPER MTTTEE SEEP PIT(S) ❑ CESSPOOLS ❑ -- VALIDATION JACK R. ALLEN CK M O CASH SUPERVISING MECHANICAL ENGINEER 61. ic"ZIAUG 20100 8.00o's