HomeMy Public PortalAbout5359 LOMA AVE_Sewer__ DEPARTD1ENT OF COUNTY ENGINEER, SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS 3S
r CASSATT D. GRIFFIN, SUPT OF BUILDING / Y• /-Qh7G v-
FOR APPLICANT TO FILL IN LOCALITY :/;qBUILDING NEAREST
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ADDRESS �j�9 � �� CROSS ST. S, O lie )T
LOCALITY.1a DISTRICT NO. ♦ SERIAL/NO. PERMIT NO. c
72-
RECEIVED BY Ready��nssp Inspection DATE 1 SUED J
NEAREST`_ s�� �
CROSS ST ��-.�, �% ,, �,,�
OWNER �f�..lL�.• .u. BSL L 5- �O 53
MAIL
ADDRESS USE ZONE I OCCUPANCY I MAP
BK PG
CITY TEL.NO. '4?
CONTRACTOR L CHARGES REIMBURSEMENT FEE
ADDRESS snf'' REQUIRED
Av NOT REQUIRED
TEL.NO._;26 f,pG.K 10B.N0. CONNECTION CHARGE FEE
REGISTRATION NO COUNTY CO.IMP. NO./37' -3 c3
LEGALs RECEIPT NO. DATE IBY
DESCRIPTION LOT NO.J. —
BLOCK TRACT //,Z/, WAIVER FOR RECORDING
SIZE OF LOT SQ N0.OF BLDGS. J RECEIPT N0. I DATE BY
/� NOW ON LOT
USE OF
BUILDINGS ,LG TRUNK PERMIT N0.
NO. DESCRIPTION OF WORK FEE
/
HOUSE
C SEWSEWERRCONNECTING TO = 3.50 3ROAD PERMIT NO. 7 3Cl_5-//e)
-PUBLHOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 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 2,Y-/3, 2 DEPTH G
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL I I UPPER //p/' X1 p{-
SPECIAL CONDITIONS ONLY - 2.00 TYPE OF CONNECTION LENGTH FROM �/ /t
Y. — CURB L-- P.L. --M.L.TO P.L 10
OWNERS PERMIT $ I 00
AUTHORIZATION I TOTAL FEE 5-D
I 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-----------------DAY OF .--------------- -----_-----. 19....... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENTV� `� BUILDING OR WORT(
ADDRESS- -------------_ SEPTIC TANK,SEEP.PIT(S)
- -- - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- , CESSPOOL ElDRYWELL❑
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 OR THAT I AM THE LEGAL OWN- I BACKFILL SEPTIC TANKS
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. I ❑
SIGNATURE
SEEP.PIT(S)❑ CESSPOOLS❑
. Gwrs6 ,
OF PERMITTEE? 6`- - -
76A642U 663 12/52