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Home My Public Portal About5353 LOMA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION CQUNTY OF LOS ANGELES WILLIAM J., FOX, COUNTY ENGINEER BUILDING �� CASSATT D. GRIFFIN, SUPT OF BUILDING ADDRESS e FOR APPLICANT TO FILL IN LOCALITY e-nn Lo e'I BUILDING NEAREST ADDRESS 5353 H. Loma Ave CROSS ST. 40 &Z / LOCALITY NEAREST Temple City ! DISTRICT NO. A SPIAL NO. PERMIT NO. C. CROSS ST. Olive Street 15-1 J RECEIVER BY_ Ready for Inspection DATE ISSUED OWNER W.J. Montry ' 01-C 3 - 2.3-,C3 MAIL ADDRESS 706 Orange Grove Way USE ZONE OCCUPANCY BK MAP PG CITY Fplsom Calif JEL NO. b \�(I CONTRACTOR CHARGES REIMBURSEMENT FEE �� ADDRESS REQUIRED CITY TEL.NO. NOT REQUIRED 1 — © �� JOB.NO. CONNECTIO`N�H�ARGE FEE REGISTRATION NO. S7e4 °7j� COUNTY CO.IMP. N0. — 3_ LEGAL RECEIPT NO. DATEBY DESCRIPTION LOT NO14 ` BLOCK ^ TRACT WAIVER FOR RECORDING NO-OF SIZE OF LOT 60 X fj NOW ON LOTS I_ RECEIPT(NO�" �`DYITE' ,BY �� M USE OF BUILDINGS Red, TRUNK PERMIT NO. �- N0. DESCRIPTION OF WOR_ K FEEHOUSE SEWER AlPUBLICS WERCONNECTING TO 0 $ 3.50 t+® ROAD PERMIT N0. ;Z- 3 3 9 A ` HOUSE SEWER CONNECTING TO •d STATE ENCROACHMENT \VI PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO. CONNECT ADDITIONAL BLDG.OR INDUSTRIAL WORK TO HOUSE SEWER 1 00 WASTE APPROVAL ----------- ALTER ®ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 STATION {�- DEPTH SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE 1 CESSPOOL—DRYWELL UPPER SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM CURB -G2 M.L.TO P.L. _ OWNERS PERMIT $ I 00 AUTHORIZATION I TOTAL FEE 0 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED ' CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS----L9--- .--.DAY OF.-... aT'Crl- ..--_...... 19__��3 NEW HOUSE SEWER -r Q� ��- 3z1 //, OWNER OR /��/ -� / CONNECT ADDITIONAL „ OWNERS AGENT`.'. - .-..._ .. ...... ....... .�l�.,i... ..--.._...... BUILDING OR WORK ADDRESS---. 535.3.__N_Loma Ave I SEPTIC TANK,SEEP.PIT(S) l� - -- -•---•------- AND/ORDRAINFIELD I 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 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 ell THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ) , SIGNATURE ` SEEP.PIT(S)❑ CESSPOOLS �(� � 3--51 OF PERMITTEE--- -- •. ..........-- --- ---------------- ...----- ( _ 76A6421) 663 12/i2 APPLICATIOIl ,FOR PERMIT' 1 BUII.DING AND SAFETY SEWER-SEWAGE DISPOSAL I of County Engineer ty of LOS Angeles 'BUILDINADDRESS SG Irl.J. FOX, COUNTY ENGINEER ,CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL-IN NEAREST .�J ' _ /��" CROSS ST. (��,�j(y�••Q/(f LEGAL _ �_J ,fir DESCRIPTION LOT N0. "'] OWNER BLOCK TRACT J� a (� MAIL ADDRESS V �} // O �G `7�� •' SIZE OF LOT tOO r 7 V NO OF BLDGS. NOW ON LOT CITY az, TEL NO. v USE OF J BUILDINGS �L.��i6 DISTRICTgW `d]ROOUP MAP BK PG' CONTRACTOR , L/ +7f/✓ �. �/� l� ADDRESS ,�-3,�-3 yJ • UVIIL CONNECTION•DATA CITY 41y a4 el TEL. NO. C,6 -9 70 7 .STATION DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO. - ❑ COUNTY UPPER LOWER TYPE OF CONNECTION LENGTH FROM NO. DESCRIPTION OF WORK FEE Y. CURB P L M L.TO P L, HOUSE SEWER CONNECTING TO _ PUBLIC SEWER a $ ,3 50 HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. JOB NO ' WORK TO HOUSE SEWER 1 00 / a� ALTER OR REPAIR EXISTING --[— _ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT DISCONNECT AND ABANDON SEWER STATE ENCRO MENT 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 C E FEE OWNER'S PERMIT $ 1 00 AUTHORIZATION TOTAL FEE ; " REIMBURSEMENT FEE HAVE CTED ITH THE ��+ TRACTORT TOS CONNECT THECONTRA ABOVEWDESCR BEDHEREIN EXISTINGNAMED DWELLING APPROVALS DATE INSPECTOR SSIGNATURE TO THE PUBLIC SEWER - SIGNED THIS-DAY OF 19- 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 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 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. PIT(S) [ICESSPOOLS[:3 SIGNATURE � OF PERMITTEE WILLIAM J. FOX. COUNTY ENGINEER v YALIDAYiON BY __�Co 5 B8 3 4 JUL 2 0 4 2'.0 0 � - DEPUTY �.(� DEP%UT�i BY BY ® DEPUTY DEPUTY -