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Home My Public Portal About4973 LOMA AVE_Sewer__ 4/72 76A642L APPLICATION FOR PERMIT 7664 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNARE �,N,-v, FOR APPLICANT TO FILL IN T LEGAL - A , DESCRIPTION LOT NO � p+v OWNER C / MAIL BLOCK TRACT - .L , ) ((/- /,q. , /-3 ADDRESS NO OF SLOGS I SIZE OF LOT NOW ON ' LOT CITY C �f TEL NO 5 USE OF < molDISTRICT NO GROUP MAP PR SSED BY BUILDINGS BK PG .��lICC////// CONTRACTOR tADDRESS J A" �V - CONNECTION DAT TEL N LIJ 3S2- STATION DEPTH STATE J t� LIC �P UPPER LICENSE NO ;3d ` CLASS �.. MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L _ML TOPIL PUBLIC SEWER @ d PC NO SEPTIC FANK SEEPAGE PIT CO IMP NO JOB NO PITS AND/OR DRAINFIELD � O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE OISPOSAL SYSTEM CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIYE■ EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER ® O OVERFLOW SEEPAGE PIT DRAINFIELD V EXTN CESSPOOL DRYWELL MANHOLE @ W ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING d SEWER OR DISPOSAL SYSTEM @ --y STATE ENCROACHMENT N (� PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER$ PERMIT S '� AUTHORIZATION TOTAL FEE / CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-i!SIEEP REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWS a,.� - APPROVALS DATE INSP CTOR S SIGNATURE SIGNED THIS DAY Oll� 1971OWNER ORNEW HOUSE SEWER OWNERSAGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESSTANK SEEP PIT(S) 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LIGATIONAND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCESAND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORALTER REPAIR SEWEROR LICENSED AS REQUIREDBY LOS ANGLESCOUNTY AND STATE OFSEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TODISCONNECT PLUG ANDRESIDE IN THE ABOVE DESCRIB RESIDENTIAL ROPERTY ABANDON HOUSE SEWER SIGNATURE ACKFILL SEPTIC TANKS ❑OF PERMITTEE ❑PIT(S) ❑ CESSPOOLS VALIDATI CK M 0 CASH I !'t 76A 6420-CE808 A-7/76 Aff'PLBCATB®N F®R1PERIC7YOT -SEWER—SEWAGE DISPOSAL COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPL.IWT TO FI LL IN DISTRICT NO GROUP 8K MAP4PROCESSED BY I BUILDING �• �J� M / �� ADDRESS CONNECTION DATA LOCALITY ' { 7 ' NEAREST - STATION 3—• - ` X DEPTH ' CROSS ST J J(J UPPER I MANHOLE REFERENCE OWNER TYPE OF CONNECTION /�>7 V LE N G TTH FROM MAIL Y CURB �P't `ML TO P IL VZ�„ ADDRESS L t/ IP'6-N O/'�'/� CITY ?"I •T�{�•�foj. o CO IMP NO �B�NO /.` - 6 LEGAL / TRUNK'PERMIT NO ROAD PERMIT NO 1 ESCRIPTION LOT NO DZ __ AFFIDAVIT WAIVER EAStMt KT f RECORD INSTR NO DATE BLOCK TRACT ^`p ^. '�� • • NO OF BLDGS ,�., - I SIZE OF LOT �Ox,/ /` NOW ON LOT HWY ORST WIDENING USE O STATE ENCROACHMENT BUILDINGS PERMIT NO " I' INDUSTRIAL CONTRACTOR WASTE APPROVAL A -CHARGES ADDRESS Y 'CONNECTION,CHARGE FEE • CITY TEL NO � ' - STATE LIC REIMBURSEMENT FEE LICENSE NO CLASSNO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE W HOUSE SEWER CONNECTING TO ) a 6.� PUBLIC SEWER a V CL SEPTIC TANK SEEPAGE PIT OR NEW HOUSE SEWER c PITS AND/OR DRAINFIELD _ CONNECT ADDITIONAL I ��• y - e HOUSE SEWER CONNECTING TO - BUILDING OR WORK �y 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 El C / 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 5 SEEP PIT(S) Cl CESSPOO ✓�►A OWNER'S Issuance Fee s S I HEREBY ACKNOWLEDGE THAT I HAVE READ HIS APPLICATION AUTHORIZATION TOTAL FEE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 9 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_ CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO OWNER OR RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY r +6WNERS AGENT SIGNATURE OF PERMITTEE ALIDATI CK M. CAS 4 2 5-JUL 7 1 0 1 5.0 0 �`�� DEPARTMENT OF COUNTY ENGIENEER ' SEWER—SEWAGE ®ISP®SAL DIVISION OF BUILDING AND SAFETY- PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER I BUILDING �5 7 3 Al 0/Yk /�w Int-7-7 FOR APPLICA TO FILL IN LOCALITY C, BUILDING NEAREST c� �-^p�(J�r D �r ADDRESS CROSS ST. �] �- ��_,v LOCALITY DISTRICT NO. SERIAL N0. PERMIT N0. C NEAREST L 0 � y S CROSS ST. C �RECEIVED,BY Ready for Inspection DATEISSUED OWNER 1-f MAIL USE ZONE OCCUPANCY I BK MAP PB ADDRESS CITY TE 0. --L CONTRACTOR 6 CO.IMP.NO. ADDRESS JOB.NO. CITY TEL N0. TRUNK PERMIT NO. TATE REGISTRATION NO. /r® Z COUNTY ROAD PERMIT N0. LEGAL M /�' ESTATE ENCROACHMENT DESCRIPTION LOT NO. /y �� —_�7 PERMIT NO. BLOCK TRACT +� ��Y�� ! INDUSTRIAL WASU PROVAL SIZE OF LOTs NO OF BLDGS. �, (� (� � �NOW ON LOT CHARGES USE OF BUILDINGS CONNECTION CHARGE FE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER ; 8.50 RECEIPT N DATE, I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER I.00 ALTER OR REPAIR EXISTING NO DATE BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 ONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 d� 4 STATION TH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 MANHO ERENCE R LOWER TYPE OFCONNEON LE FROM Y. CUR P.L. M.L.TO OWNERS PERMIT $ 1 00 AUTHORIZATION I TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR/14 SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS----..--...DAY OF..----.--19__._ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL L OWNERS BUILDING OR WORK SEE ADDRESS.............__..___-. A'ND7OR'DN INF I EL 1 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL[:] DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE 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 DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR AT 1 AM HE L L OWN- ER OF THE ABOV DENTI R RTY. BACKFILL SEPTIC TANKS El SIGNATURE SEEP.PIT(S)E] CESSPOOLS E] OF PERMITTE -.......... ......... .............._....... 76A642A 663 7/53