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Home My Public Portal About5426 LOMA AVE_Sewer__ 76A642D APPLICATION FOR PERMv,1 76A642I.1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPO AL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Bu>ldmg LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROSS ST LEGAL le DESCRIPTION LOT NO / OWNE �,i% Ile— DE BLOCK TRACTADDRE NO OF BLDGS SIZE OF LOT NOW ON LOT CITYCs TEL NO USE OF DRICT N `GROUP P MAP PROC ED BY BUILDINGS ISTBK G J CONTRACTO ADDRESS CONNECTION DATA ION DEPTH CITY f TEL NO � ,(J STATE PPE REGISTRATION NO COUNTY MANHOLE REFERENCE NO DESCRIP ION OF WORK FEE TYPE OF CON NECTIO LENGTH FRO ` d HOUSE SEWER CONNECTING TO Y CURB M L TO P LO PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO V PITS AND/OR DRAINFIELD @ 31000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N 1 O PRIVATE DISPOSAL SYSTEM @ $300 /G- 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAiv Ea EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ 3300 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 ALTER EPAIR OR ABANDON HOUSE HWY OR ST WIDENING _ SEW OR DISPOSA SYSTEM @ $3 00 STATE ENCROA MENT /] PERMIT NO I NDU5TRIAL r WASTE APPROVAL CHARGES OWNERS PERMIT s AUTHORIZATION TOTAL FEE 02 Cra CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO 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 ADDRESS BUILDING OR WORK SEPTIC TANK SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL 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 A DESI,RIBED :FTZOPERTYABANDON HOUSE SEWER SIGNATURE _ ,(/OF PERMITTEE ES RI /(/� N✓ BACKFILL SEPTIC TANKS ❑ _ SEEP PIT(S) ❑ CESSPOOLS y. VALIDATION ROBERT A. WOOD CK M 0 CASH SUPERVISING MECHANICAL ENGINEER 3 "z 76AB42D APPLICATION FOR PERMW� 6A6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISP SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUDILDING JOHN A. LAMBIE, County Engineer ADRESS WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST 11001, FOR APPLICANT TO FILL IN CROSS ST. LEGAL // DESCRIPTION LOT NO. _ OWNER "GS MAIL BLOCK TRACT ADDRESS NO. OF BLD G5. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS S DISTR T NO. GROUP MAP PROCED BY BK PG CONTRACTOR ADDRES ✓ CONNECTION DATA A IONDEPTH CITY. TEL. N �7 TATE _ PPE MANHOLE REFERENCE REGISTRATION NO. COUNTY NO. DESCRIPTION OF WORK FEE TYPE:MTION LENGTH F M HOUSE SEWER CONNECTING TO U P.L. PUBLIC SEWER @ $5.00 SEPTIC TANK.SEEPAGE PIT OJAR B NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. OB NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N O PRIVATE DISPOSAL SYSTEM @ $3.00 E CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE y WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN.,C ESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENINGZ SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROA MENT r PERMIT NO. / INDUSTRIAL 64 WASTE APPROVAL OWNERS PERMIT E 2 00 CHARGES AUTHORIZATION TOTAL FEE 1n/I CONNECTION CHARGE FEE 1 HAVE 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 I NSPECTOR'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 HEREBYACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LLICENSED AND SEWERS. CESSPOOL ❑ DRYWELL ❑ CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR '. S REQUIRED BYLOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND THE A DESCRIBED REST TIAL ROPERTY. ABANDON HOUSE SEWER rTTEE BACKFILL SEPTIC TANKS ❑ SEEP,PIT(S) ❑ CESSPOOLS ❑ 1 1 VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. /-11'!' i,Wiz.��