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Home My Public Portal About5311 LOMA AVE_Sewer__ '7SA642D ��t, APPLICATION LICATION FOR E � tl ■MIT +'S8 E 2.D 4 12-54 I _ ` ` -DjVISIdN OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL , DepaThnent of County Engineer County of Los Angeles v ADDRESS ' WM. J. FOX, COUNTY ENGINEER I _ CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY r, FOR APPLICANT TO FILN NEAREST L I CROSS ST. C.� lti.ed LEGAL Z f DESCRIPTION LOT NO.4� /f Ll/.'YT."r ! OWNER 1- >, - BLOCK til TRACT MAIL ADDRESS �c NO OF BLDGS. - SIZE OF LOT ( NOW ON LOT CITY TEL NO USE OF BUILDINGS C� DISTRICT NO. GROUP MAP BK P CONTRACTOR 11) _ ADDRESS T�,S � CONNECTION DATA STATION �"ff�" n DEPTH &–STATE A M REFERENCE REGISTRATION NO. ` ❑ COUNTY t —C \' UPPER LOWER � TYPE OF CONNECTION LENGTH FROM dr2-Gq�t, NO _ DESCRIPTION OF-WORK FEE Y,"!•\ CURB P L M L.TO P L. HOUSE SEWER CONNECTING TO "PUBLIC SEWER Q $ 3 50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR CO IMP NO. 777 JOB NO. WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO -- SEPTIC TANK, SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNERS PERMIT S t �_co AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTORHAVE TTO CONNECTHIS DATE ONTRTHEA ABODVE WITH DESCRIBED EXISTINGNAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER _ SIGNED THIS�_DAY OF Ly y t9 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT / BUILDING OR WORK _ SEPTIC TANK, SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL ElDRYWCLL C:1 - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR 1„F,ICUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM ' I4HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS-ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP.PI'I(S) ❑ CESSPOOLS❑ SIGNATURE OF PERMI'4g?m WILLIAM J. FOX-`CouNTY-ENGINEEFf VALIDA'T'ION C09 3 9 - -OCT 2 5 4.5 v 10 BT BY DEPUTY DEPUTY BY BY �• ® DEPUTY - DEPUTY C E808 10-63 7 76A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBLE, County Engineer ADDRESS r LUM WILLIAM A. JENSEN, Sup't of Bu>lctmg Te All <I LOCALITY NEAREST FOR APPLICANnT TO FILL I/N/, CRD15 STLEGA p{� / L DESCRI TION LOT NO OQ( (({ �� OWNER [J�G..(!O LItI/ 7� GoAe�T, ) MAIL BLOCK `TRACT ADDRESS-722— NO DDRESS 22 SIZE OF LOT 5 NOWOON LOTS r CITY 4 �+ F TEL NO USE OF �/� �� AMIL BUILDINGS DISTRICT NO GROUP BK MAP PROCESSED BY PG CONTRACTOR ADDRESS 722 �* ()&L-L ONNECTION DATA CI7 TEL NO Z (� STATION TATE �jJ DEPTH 6j REGISTRATION NO COUNTY J MANHOLE REFERENCE s)L/ _ v C/ ,v NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL M L TO P L PUBLIC SEWER @ $5 00 SEPTIC TANK,SEEPAGE PIT OR P C NO O PITS AND/OR DRAINFIELD @ $1000 CO IMP NO / JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 ^ CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE V0 WORK TO HOUSE SEWER @ $3 00- SV• OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL,DRYWELL,MANHOLE @ $5 00 / TR•9C.ABANDON HOUSE HWY OR ST WIDENING JL4 N SEWER O @ $300 V-� STATE ENCROACHMENT e/��d//��`��//// PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 21 00 CHARGES AUTHORIZATION TOTAL FEE G 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 APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECTADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP,PITS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 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 H THAT 1 DE THE LEGAM,F , AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO DESCRI D PR PERTY ABANDON HOUSE SEWER SIGNATURE _ BACKFILL SEPTIC TANKS ❑ V OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD cK M o CASH SUPERVISING MECHANICAL ENGINEER LACO 7 8 1-5 2 9 1 a o 5.00- TEMPLE CITY temple city 76 5-65 6642D APPLICATION FOR PERMIT 766 64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ENEAREST 311 N. Lorna Ave. JOAN A LAINIRIE county Engineer COLEMAN IN JENKINS Sup't of Building Temple City olive St o FOR APPLICANT TO FILL IN 1 LEGAL Euclid Const. DESCRIPTION LOT NO OWNER MAIL 722 E. Valley Blvd. BLOCK TRACT ADDRESS NO OF BLDGS _ SIZE OF LOT NOW ON _LOT CITY an GabriejEL NO USE OF DISTRICT NO GROUP MAP PRO ESSED BY BUILDINGS Rps . f� 6K PG CONTRACTORS care Deal Sewer SerV1CeG/ --- C� ADDRESS2933 r q - Rd. CONNECTION DATA CITY El MOnLe TEL NO 444-2020 STATION DEPTH 7 LICENSE LICENSE ,� UPPER NO CLASS C 2 MANHOLE REFERENCE f !\ 128870 NO [DESCRIPTION OF WORK FEE TYPE OF CONNECTION LE GTH FR M HOUSE SEWER CONNECTING TO Y CURB P L M L TO P PUBLIC SEWER C $ 5 00 SEPTI ANK, SEEPAGE PIT OR - -- - __ PC NO d PITS AND/OR DRAINFIELD C $1 0 00 CO IMP NO JOB NO O HOUSE SEWER CONNECTING TOV TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM C'' $ 3 00 ix CONNECT ADDITIONAL BLDG OR $ 7 k-�/� AFFIDAVIT WAIVER 11114INT RECORD INSTR NO DATE O WORK TO HOUSE SEWER C 3 00 ��(! RE A R ABANDON HOUSE V SEWER OR DISPOSAL SYSTEM C $ 3 00 W HWY OR ST WIDENING d E%TN CESSPOOL MANHOLE C' $ 5 00 1N STATE ENCROAC HMENT Z PERCOLATION TEST @ $ 5 O0 PERMIT NO INDUSTRIAL ' WASTE APPROVAL � C� OWNERS - PERMIT $ z 00 CHA GES AUTHORIZATION TOTAL FEE CONNECTION C ARGE FEE IHAVE 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 IS 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 LICENSEDAS 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'VOPE ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ (IOF PERMITTEE ❑ 471 SEEP PIT(S) CESSPOOLS VALIDATION CK M O CASH Lko84060 MY 8 1 0 D 5.00- -