HomeMy Public PortalAbout5452 LOMA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER 41 - SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER �I BUILDING C��� / ,7�
ADDRESS `J LD
NG FOR'APP.L+IIC�A,,NT,y�'JO, FILL IN LOCALITY 77 G'l
NEAREST
ADDREBUIL SS ,� .�Z /6�/ py(/�bLGC� CROSS ST. �O��yY//T ✓
LOCALITY
DISTRICT NO. SERIAL NO. PERMIT NO.
C
NEAREST A lD $
CROSS ST
RECEI�V+E-D.BY7 Ready for Inapeotlen D TE ISSUED
OWNER � ��Z.
MAIL USEZONE OCCUPANCYy
ADDRESS
�j�j g . �c+ ,(B/K� PO
CITY�• TEL.NO. / 3 Imo/ � ..7
CONTRACTOR �G/'��- '✓L_ CO.IMP.NO. 13 -77
ADDRESS J L / S I
JO
CITY ,I� '• TEL.NO. TRUNK PERMIT N0.
ST TE
REGISTRATION NO. COUNTY ROAD PERMIT NO. Z�I16
LEGAL ,yy-- STATE ENCROACHMENT
DESCRIPTION LOT N0. �� • J•D PERMIT NO.
BLOCK TRACT 7-7 INDUSTRIAL
WASTE.APPROVAL
SIZE OF LOT NO.OF BLDGS.
�f SX ��� NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK Z FEE
/ HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE,
PUBLIC SEWER @ $ 3.50 RECEIPT NO. A E BY*_ '
HOUSE SEWER CONNECTING TO
PRIVATE'DISPOSAL SYSTEM 1.00
CONNECTADDITIONAL BLDG.OR EXCEP ON RECO DED
WORK TO HOUSE SEWER 1.00 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM I.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 5_74T 'y y DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ,// MANH+i OLEREFERENCE- 13 LOWER
TYPE ZrTION LENGTH FROM
OWNERS PERMIT I 00 Y.- LOUR P.L. M.L.TO P L•
AUTHORIZATION -TOTAL FEE S� _
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOV DESCRIB D EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE/�1iPUBLIC SEWER
/l ......DAY OF.._......_._. P_Iq_ NEW HOUSE SEWER
SIGNED THIS_....... _ . __._.....-.... �-�
OWNER OR' j(�L�Qr�,Ld BUILDING OR WORKECT OWNERS AGENT ......._. _
ADDRESS._�T. _ ..!._`��!. �'�'' ' h /. SEPTIC TANK,SEEP.PIT(S)
_ _... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL E] _
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT IAM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATRE SEEP.PIT(S)C) CESSPOOLS
U
OF P.ERMITTEE--- - ............ - --------•----- -
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