HomeMy Public PortalAbout5345 LOMA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEINER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM-J. FOX, COUNTY ENGINEER BUILDING 53 5
CASSATT D. GRIFFIN, SUPT DF BUILDING ADDRESS /Y7G '
FOR APPLICANTTO FILL IN I LOCALITY 7,ej),)'04 6A4 JJ
ADILDING NEAREST
DRESS .� /Yo _ Qk)q CROSS ST. ,D/C 11 VY:l �T
LOCALITY 'T//�,,,-�p/e (��lt �-y ��/��' DISTRICT NO. SERIAL NO. PERMIT NO.NEAREST
C
CROSS ST. ((J I/VP A
fir* Q / RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ehY 11l e �l l]0 ek h, L1__ j
MAIL
ADDRESS $,3 g+��6 �Q m a kz�(� USE ZONE OCCUPANCY' BK MAP PG
CITY7�vrl oIe_ C//pp1 /! TyL.NO. i��, G4-7;2a�
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS h// T / y� S' ')' REQUIRED
NOT REQUIRED
CITY /„�[� TEL.NO. A6 Lie GJOB.NO.
G 6� CONNECTION CHARGE FEE
�=I
��� TCO3� -IREGISTRATION NO. '0 COUNTY
LEGAL c RECEIPT NO. DATEI BY
DESCRIPTION LOT NO. t_
BLOCK )�7 TRACT 1 WAIVER FOR RECORDING
SIZE OF LOTy NO.OF SLOGS. RECEIPT NO. I DATE BY
40 �Ikao NOW ON LOTT
USE OF pp
BUILDINGS eH '� CL TRUNK PERMIT N0.
NO. DESCRIPTION OF WORK FEE J
HOUSE SEWER'CONNECTING TO - '" 2 ZS' yi /X a r
PUBLIC SEWER Q ; 3.50 ROAD PERMIT N0. [1
3 �':
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 I WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM _ 1.00
SEPTIC TANK,SEEPAGE PIT OR STATION 3 f 5�, 5 DEPTH �� !
PITS AND/OR DRAINFIELD ° 2.00f:j- MANHOLE REFEREII��C `�
CESSPOOL—DRYWELL UPPER 7 'Z,�(j /V[>><'POWE'R
SPECIAL CONDITIONS ONLY 200 I TYPE OF CONNECTION LENGTH FROM It
Y. CURB ✓P.L, M.L.TO P.L.
OWNERS PERMIT I 00
I1
AUTHORIZATION TOTAL FEE
I
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR' IGNATURE DATE
DWELLING TO THE�PUBLIG SEWER �^
SIGNED THIS______ _______DAY OF._ C� !.._...__._._.... 19.�_ NEW HOUSE SEWER /O
- CONNECT ADDITIONAL
OWNER OR /y/� - BUILDING OR WORK
OWNERS AGENT___..1...� rM�'t...............
-�5i'{ �. '� _ �� SEPTIC TANK,SEEP.PITS) `
ADDRESS��. "5- yw = - `' ---.-. c AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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
REEULAT!NG PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THATRE AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA CR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E
SIGNATURE
SEEP.PIT(S)E] CESSPOOLS ! �
�` / /� -
OF PERMITTEE
N• 76A6421) 663 I2/52