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HomeMy Public PortalAbout5312 LOMA AVE_Sewer__ 76A 642D - CE808 - 9/73 APP1le CATH IrOR P mIT . COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _ r/ ADDRESSl('�/n/�J AGS LOCALITY I P-f"10 R ,7 /i �/✓ FOR APPLICANT TO FILL IN NEAREST CROSS ; GROSS ST ,(j�I/,(�/ LEGAL462 p DESCRIPTION LOT NO OWNER "e/ MAIL _ BLOCK TRACT s T./ ADDRESS 30 -I,3 A-J. X a rj9 ,j 41 NO OF BLDGS SIZE OF LOT NOW ON LOT CITY/P,0" n,,er:" TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP SSED BY � BK P3 CONTRACTOR cv.cr �, d 8 — lv , ADDRESS / ,(©/jJ.lq /jI�/� CONNECTED DATA ./ / STATION DEPTH CITY 101y7�� � i I( TEL NO pc^ O� STATE LIC MANHOLE REFERENCE UPPER LICENSE NO CLASS LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL ML TOP L PUBLIC SEWER 0 $7 00 PC NO SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD f10 00 CO IMP.NO JOB NO HOUSE SEWER CONNECTING TO 'TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM S300 CONNECT ADDITIONAL AFFIDAVIT I WAIVER I EASEMENT I RECORD INSTR NO DATE WORK TO HOUSE SEWER ® $300 OVERFLOW SEEPAGE PIT DRAINFIELD Q EXTN CESSPOOL DRYWELL S500C-1 OR ST WIDENING V ALTER REPAIR OR ABANDON HOUSE ` SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT OCD MANHOLE $7 00 PERMIT NO v CD INDUSTRIAL wi O. WASTE APPROVAL � OWNER'S PERMIT s o CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL 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 I NSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANKSEEP;PIT(S) I HEREBY ACKNOWLEDGE THAT 1 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 LICENSED AS REOUIRED BY LOS ANGLES COUNTY AN STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I M THE LEGAL OWN OF INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABO ESCRIBF�D RESIDE IAL OPERT ABANDON HOUSE SEWER SIGNATURE e__ BACKFILL SEPTIC TANKS ❑ OF PER MTTTEE ��E����--����//// `' T SEEP PIT(S) ❑ CESSPOOLS ❑ tl ALEDAT•ON K. M.0. CASH 4 84 tI-9,IR .21 10 ®, 9.0 0 Ay8 &E-6D S 83 11-55 APPLICATION FOR\ Y_ OER.aLIT&E-8 DIVISION'OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Dep=onent of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �(1' ® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. ea LEGAL OWNER DESCRIPTION LOT NO MAIL BLOCK TRACTADDRESS Z -2 A NO. OF BLDGS. CITY �_ TEL. N0. SIZE OF LOT NOW ON LOT USE OF DISTRICT' 0. GROUP I MAP BUILDINGS BK PG CONTRACTOR M. ADDRESS ;� CTION DATA 'A STATION DEPTH I CITY TEL. N0. (i`� (j MANHOLE REFERENCE PPER ❑ STATE REGISTRATION NO. / p ❑ COUNTY NO. DESCRIPTION OF WORK FEE P HOUSE SEWER CONNECTING TO TYPE OF TION LENGTH FROM Y. CURB P.L M.L.TO P.L. PUBLIC SEWER @ $3 50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 _ OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO. EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO. JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL ' CHARGES CONNECTION CHARGE FEE OWNER'SPERMIT S 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE - I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECLPR�355 G gTURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER/ - NEW HOUSE SEWER SIGNED THIS D�OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK - OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIA PROPERTY / BACKFILL SEPTIC TANKS Fer •' SEEP PIT(S) ❑ CESSPOOLS❑ SIGNATURE '„��� I OF PERMITTEE JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR • CK, N 0 CASH r _ •• O.3 9 2 S JAN 15 4 A 4 5.,0 .9 0-63 76A642D APPLICATION FOR ERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS 3 WILLIAM A. JENSEN, Sup't of Building Com/ LOCALiTV QL.- NEAREST - FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO UZ MAIL BLOCK TRACT ADDRESS OF BLDGS 1' �/ O SIZE OF LOTVlr JOW ON LOT CITY /7 TEL NO '00 Ar USE OF BUILDINGS L DISTRICT NO GROUP MAP PROCESSED BY / BK / PG CONTRACTOR O 6 ADDRESSZy�Z/ CONN CTI DAT STATION / ,.S"y DEPTH CITY TEL NO Y/ ❑ STATE MANHOLE REFERENCEUPP REGISTRATION NO ❑ COUNTY LOWER NO DESCRIPTION OF WORK FEE -TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL ML TO P L PUBLIC SEWER $5 00 SEPTIC TANK SEEPAGE PIT OR PC NO O PITS AND/OR DRAINFIELD @ $1000 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO im PRIVATE DISPOSAL SYSTEM @ $300 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIYEII EASEMENT RECORD INSTR NO DATE `,J WORK TO HOUSE SEWER @ $300 7V• OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN CESSPOOL,DRYWELL MANHOLE @ $500 d e'Tom" "�""".11 ABANDON HOUSE HWY OR ST WIDENING W SEWER 044. PG9ML SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 21 00 CHARGES AUTHORIZATION I TOTAL FEE ia_V CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBEDEXISTING DWELLING TO THE PUBLIC SE E APPROVALS DATE INSPECTOR S SIGNATURE h SIGNED THIS DAY OF 1 OWNER OR NEW HOUSE SEWER OWNERS AG �,�: < CONNECT ADDITIONAL BUILDING OR WORK ADDRESS ' SEPTIC TANK,SEEP PIT(S) 1 HERE Y ACKNOWLEDGE THAT [ HAV READ THIS APPLICATION AND/OR DRAINFIELD AND STA THAT THE ABOVE IS COR. T AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING E]PLUMBING NO SEWERS CESSPOOL ❑ DRYWELL I HEREBY ERTIFY 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 O THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN, TH ABOV ESCRI ARES DE TIAL PR//nOP TY ABANDON HOUSE SEWER SIGNATURE ,�� �,Y BACKFILL SEPTIC TANKS ❑� OF PERMITTE ///��� SEEP,PIT(5) ❑ CESSPOOLS ❑ VM O CASH ALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK LAL0 7 5 9 3 MAR 15 1 0 0 5.0 0- TEMPLE CITY CE808 5-85 76A 642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING r 12 N. Loma Ave. JOHN A LAMBIE County Engineer ADDRESS 5 3 COLEMAN JENKINS Supt of Building Temple �i1t LOCALTY NEA RE5T Olive S C�i- FOR APPLICANT TO FILL IN CROSS 5T l� LEGAL DESCRIPTION LOT NO OWNER Euclid Const. MAIL BLOCK TRACT ADDRESS 22 E. Valley Blvd, NO OF BLDGS ,San Gabr ie� SIZE OF LOT NOW ON LOT CITY SEL NO USE OF DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS BK /J PG CONTRACTOR SquarpeSewer _J (� ADDRESS 2933 CO ECTION DATA CITY R1 MonteTEL NO STATION DEPTH LICENSE LICENSE NO 128870 CLASS C-42 MANHOLE REFERENCE / NO DESCRIPTION OF WORK FEE TYPE OF CONNECTI -LEN6p FRO HOUSE SEWER CONNECTING TO Y CURB P L ML TOPIL PUBLIC SEWER C< $ 5 00 y. SEPTICTANK SEEPAGE PIT OR PC NO d PITS ANDIOR DRAINFIELD C" $10 00 CO IMP NO JOB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO U PRIVATE DISPOSAL SYSTEM C $ 3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT . IVE1 EASEMENT RECORD IN5TR NO DATE O WORK TO HOUSE SEWER @ $ 3 00 F- 'ALILH, REPAIR OR ABANDON HOUSE U SEWER OR DISPOSAL SYSTFM C $ 3 00 W HWY OR ST WIDENING d EXTN ,CESSPOOL, MANI+OLE 0 $ 5 00 h STATE ENCROACHMENT Z PERCOLATION TEST @ $ 5 00 PERMIT NO f INDUSTRIAL Q `i WASTE APPROVAL CHARGES_' OWNERS PERMIT $ 2 00 CONNECTION CH RGE FEE AUTHORIZATION TOTAL 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 INSPE 1R 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 APPLICATIONAND/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 El C)I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY L05 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT IAM THE LEGAL OWNER OF AN INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PR ERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK M O CASH t C0 8 4 Q 7:a MAY 81 0 0 5.0 0-