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Home My Public Portal About5422 LOMA AVE_Sewer__ E-6633 S&E-663 11-55 APPLICATION FOR PERMIT rJ, 5&E DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. LEGAL ' DESCRIPTION LOT NO. r. "' i. f.�' OWNER x MAIL BLOCK TRACT kI ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT +''"""• CITY TEL. NO. .. USE OF - - - t DISTRICT NO. GROUP MAP BUILDINGS 7�] BK PG CONTRACTOR CONNECTION DATA ADDRESS STATION DEPTH CITY TEL. NO, MANHOLE REFERENCE UPPER C1 STATE LOWER REGISTRATION NO. ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM , PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L.TO P.L. 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. N0. JQB NO. HOUSE SEWER CONNECTING TO I PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT N0. C6- N'$CT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO, OUSE SEWER @ $1.00 PERMIT NO. ALTER,RERAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 51 t Oo REIMBURSEMENT FEE AUTHORIZATION I TOTAL FEE ,;- I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONCESSPOOL❑ 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 1 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 I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S) [I CESSPOOLS❑ OF PERMITTEE JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR CK. Y.O. CASH 76A 4 APPLICATION FOR PERWIAT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS a, .e.. WILLIAM A. JENSEN, Sup't of Building �y LOCALITY 0/ NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO l OWNER c MAIL BLOCK TRACT 17-7 q( ADDRESS NO OF BLDGS SIZE OF LOT 6 NOW ON LOT / CITY TEL NO Q USE OF q BUILDIr NGS DISTRICT NO GROUP MAP PROCESSED BY BK PG CONTRACTOR a � ADDRESS j/ oV CO NECTION DATA CITY TEL NO 6,r jam. do STATION DEPTH ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO ElCOUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER @ $5 00 P C NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO PITS AND/OR DRAINFIELD @ $1000 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM 0 $3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ S500 ABANDON HOUSE HWY ORST WIDENING b y SEWER GEMMMMMMD-SYSTEM CSP $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WA TE APPR VAL OWNERS PERMIT s z o0 N CHG AUTHORIZATION TOTAL FEE CON NECTI AR EE IHAVE 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 I /DATE/ INSPECT0R'S_�1,yPT TURE SIGNED THIS DAY OF OWNER OR NEW HOUSE SEWER ..1% OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY 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 OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND ' RESIDE IN THE ABOVE /DESCRIBE D SIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE �(/,(//d BACKFILL SEPTIC TANKS ❑ ❑ _ SEEP PIT(5) ❑ CESSPOOLS VALIDATIONROBERT A. WOOD M O CASH SUPERVISING MECHANICAL ENGINEER CK �tiia 3 � 9'cj i 4 � 1 J D 55,00" 76A842D 1D_82 APPLICATION FOR PERMIT 78A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING t jL ADDRESS — JOHN A. LAMBIE, County Engineer J �/ WILLIAM A. JENSEN, Sup't of Building / LOCALITY NEAREST FOR APPLICANT TO FILL CROSS ST. LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS I! NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS It DISTRICT NO. GROUP MAP PROCESSED BY BK CONTRACTOR ADDRESS Q CONNECTION DAT L CITY TEL. NO. ION DEPTH ElSTATE MANHOLE REFERENCE >•' REGISTRATION NO. (O Q ❑ COUNTY t LOWER a NO. DESCRIPTION OF WORK FEE TYP F N ION LENGTH F M / O / HOUSE SEWER CONNECTING TO Q C P.L] M.L.TO P. . V PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR 17,7 P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. 3 JOB NO. O HOUSE SEWER CONNECTING TOL) ~ PRIVATE DISPOSAL SYSTEM @ $3.00 TRUNK PERMIT NO. ROAD PERMIT NO. ,{E / W CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. V DATE a WORK TO HOUSE SEWER .00 h OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING _ SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPR AL CHA OWNERS PERMIT $ 2 00 e^ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE rf IHAVE 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 INSPECTOR'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 APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL 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 REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED PROPERTY. ABANDON HOUSE SEWER SIGNATURE t OF PERMITTEE ( BACKFILL SEPTIC TANKS ElSEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. CA842D°-82 7APPLICATION FOR PERMIT 78A 842 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION VNEAREST JOHN A. LAMBIE, County Engineer !� 4/ WILLIAM A. JENSEN, Sup't of Building FOR APPLI ANT T FII.L LEGALDESCRIPTION LOT N MAIL BLOCK TRACT ADDRESS NO OF BLDGS / SIZE OF LOT NOW ON LOT CITY TEL NO _ USE OF DISTRICT-NO GRO MAP PROCESSED BY BUILDINGS BK �PG CONTRACTOR ADDRESS Q CONNECTION DATA CITY \ i TEL NO �p / �� 9 S r- ON DEPTH �JEl / REGISTRATION NO ,�J /' ❑ COUNTY MANHOLE REFERENCE / LOWER NO DESCRIPTION OF WORK FEE TYP F N CTION ENGTH F M a HOUSE SEWER CONNECTING TO P M L TOP 11W O PUBLIC SEWER @ $5 00 C NO SEPTIC TANK,SEEPAGE PIT OR r 4377 J PITS AND/OR DRAINFIELD @ SIO 00 CO IMP NO OB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM @- $3 00 {� CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EAS Ex ExT RECORD INSTR NO DATE uj WORK TO HOUSE SEWER @ E3 OO _ OVERFLOW SEEPAGE PIT DRAINFIELD to EXTN CESSPOOL,DRYWELL,MANHOLE @ E5 00 Z ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEW R OR DISPOS L VSTEM @ E3 00 STATE ENCROACHMENT - PERMIT NO INDUSTRIAL WASTE APP VAL OWNERS PERMIT $ c s 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 SEWERAPPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WO ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP PITS) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ANO/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ESSP^'--' PLUMBING AND SEWERS CESSPOOL❑ DRYWELL ❑ - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORN IA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY gBANDO HOUSE SFW,EF3-„ SIGNATURE 1 AN PERMITTEE % C�� BACKFILL SEPTIC TANKS ❑ SEEP,PITS) ❑ CESSPOOLS ❑ ALIDATION ----_ROI§ERT A. WOOD cK M O CASH SUPERVISING MECHANICAL ENGINEER 5 3 6 5' 14 L�iGo A..Y 2 9 1 1 D2 5.00-,