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Home My Public Portal About5327 LOMA AVE_Sewer__ 8 d fi•889 9.89 APPLICATION FOR PERMIT DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL. Department of County Engineer igimcm County of Los Angeles BUILDING WM.J. FOX, COUNTY ENGINEER ADDRESS 3 ` P CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY ( FOR APPLICANT TO FILL IN cRoss ST. e i LEGAL DESCRIPTION LOT NO. OWNER d N ,� P MAIL �� ADDRESS BLOCKjE7 TRACT � 7. � z-1 U / NO. OF BLDGS. l SIZE OF LOT al joy NOW ON LOT CITY TEL. NO. USE OF � BUILDINGS 0f Q DISTRICT NO. GROUP BK I MAP. PG CONTRACTOR -15 J ADDRESS -le-7'9 ! Ziaz r'_ s �?d CONNECTION DATA CITY '�L Al In� TEL. N0.�©f 29b-� STATION '��J I �, DEPTH f 19 STATE MANHOLE REFERENCE I� REGISTRATION NO. O ❑ COUNTY / WE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO ,�iT TYPE NF,CTION LENGTH FROM PUBLIC SEWER .� CURB,/ ,�6rL� M.L. TO P.L. Q $ 3.50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM .1.00 _ CONNECT ADDITIONAL BLDG. OR J P. C. N0. WORK TO HOUSE SEWER 1.00 CO. IMP. NO./ 7 JOB NO. ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT NO.3z-?-y SEWER OR DISPOSAL SYSTEM 1.00 ,L DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINFIELD 3.00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES PERMIT CONNECTION CHARGE FEE OWNER'S $ 1 00 AUTHORIZATION TOTAL FEE v. �;z REIMBURSEMENT FEE TRACTORHAVE TTOS CONNECTDATE O THEA ABOVECTED WDESCRIBED EXSTINGITH THE HEREIN A DYELLIING APPROVALS_ DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER / A - SIGNED THIS DAY OF toi /„ NEW HOUSE SEWER W f' CONNECT ADDITIONAL OWNER OR OWNERS AGENT BUILDING OR WORK _ SEPTIC TANK, SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL 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 I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT IAM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS C SEEP. PIT(S) ❑ CESSPOOLS.e a}?�(,/ � SIGNATURE OF PERMITTEE WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR t_ o 6 5 7 2. Mr,Y 31 4 4.5 0 i Q .