HomeMy Public PortalAbout5456 LOMA AVE_Sewer__ DEPARTAI[ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING ,^n'
ADDRESS S �,S to N Gr7 G37GY
FOR APPLICANT TO FILL INBUILDING LOCALITY j��a/G- G i
ADDRESS �� /V.�D NI A CROSS ST. Q QA2k l Q�/ C,
LOCALITY M �p L fP�`'t r y DISTRICT NO. A SER SAL NO. PERMIT NO.,
NEARESTCROSS ST. Bpi -t ' D W A X --F—O �� �d
RECEIVED BY Ready for Inspection DATEISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP 1
ADDRESS I I BK,
CITY r, v TEL.NO4 f,(O D
CONTRACTOR
CO.IMP.NO. 3 ��
ADDRESS 4� JOB.NO.
CITY TEL.NO./ (�l� Ia(zj TRUNK PERMIT NO.
REGISTRATION NO. R` COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO.
PERMIT NO.
BLOCK TRACT INDUSTRIAL n
WASTE APPROVAL d"
SIZE OF LOT 91 2_,4 l � NO'OW ON LOTS CHARGES
BUILDIDINGS
USE Q� j r � �, r CONNECTIONaHARGE FEE /
- - ! �
NO. - DESCRIPTION OF WORK - FEE
HOUSE SEWER CONNECTING TO j REIMBURSEMENT FEE---,,
PUBLICSEWER @ $ 3.50 3 RECEIPT NO. ' DAT` E BY
HOUSE SEWER CONNECTING TO
PRIVATEDISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR / EXCEPTION RECORDED
WORK TO HOUSE SEWER. 1.00 NO. DATE` BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION.DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 I STATIONo 7 l DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 (o MANHOLE REFERENCE
1C / �� &J UPPER L'OR�a
TYPE OF CONNECTION LENGTH FROM �D i
OWNERS PERMIT $ I 1 00 _X . CURB ,.r P.L.L — M.L.TO
AUTHORIZATION TOTAL FEE I 4- -.fz'
I 'HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDi as
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING, APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--___ _- d9 I NEW HOUSE SEWER Jy�
- .._ _..D Y OF---_--_.-_.._.._�...___.._19__. �' !'-�:•'= l
OWNER OR ���� ---/, CONNECT ADDITIONAL
OWNERS AGENT--;..____--_;__---- ___
7 BUILDING OR WORK
` SEPTIC TANK,SEEP.PIT(S)
ADDRESS :-.. - =-- - - - - _-...- ' AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI-> CESSPOOL Q_DRYWELL ,, •'{, f I,
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE e
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFI LL SEPTIC TANKS Ej -
/ ! SEEP.PIT(S)[:] CESSPOOLS
SIGNATURE q/� ,/ �J
OF PERMITTEE.-- --- -••--_-
76A642D 663' 1/53 -
DEPARTMENT 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 /��� 17-"lwt_E�,
FOR APPLICANT TO FILL IN LOCALITYBUILDING
ADDRESS / y NEARESTCROSS ST:
LOCALITY DISTRICT NO! SERIAL NO.✓ PERMIT NO.
NEAREST A ����r
CROSS ST.
+/' RECEIVED BY Ready for Inspection DATEISSUED
OWNER Ie / q`�
MAIL 1 OCCUPANCY USE ZONE OC MAP
ADDRESS I y
BK P8
CITY TEL.NO.
CONTRACTORll-r:3 CO.IMP.NO.
ADDRESS /]f �� f�r ' �"' JOB.N0.
CITY / TEL_NO.//_,o Cpa �9 TRUNK PERMIT N0.
REGISTRATION NO. n g �j COUNTY ROAD PERMIT NO. �73 )
LEGAL / r STATE ENCROACHMENT
DESCRIPTION LOT N0. "�/ PERMIT NO.
BLOCK TRACT INDUSTRIAL
�1 WASTE APPROVAL
SIZE OF LOT ✓ N0.OF BL GS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE F,EE
NO. DESC IPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUB_LICSEWER @ $ 3.50 I RECEIPT NO. I DAT I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.ORQ v EXCEPTION ECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I / DAT I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 C,&NNECTION DA
SEPTIC TANK,SEEPAGE PIT OR
PITS AHD/OR DRAINFIELD 2.00 STATION / DEP H
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I / MANHOLE REFERENCE
UPPER LOWER
TYPE OF,CONNECTION LENGTH FROM
OWNERS
Y. jCURB P.L.- M.L.TO P.L.
PERMIT ; I I 00 J
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED;
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOWS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_/ ___DAY OF----------- ---- 19 J HEW HOUSE SEWER l / 3
/ CONNECT ADDITIONAL
OWNERS AGENT
OWNER- OR �Cf' BUILDING OR WORK
K."-_ "+,-�• - - ----_t
SEPTIC
ADDRESS 1 __ ____Lft-r / -.-._____-.1 AND/OR DRAINF ELD ITIS)
p9�,roa�-" "
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Q-;DRYWELL E] �(� f j
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE �!/f/lithe
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS I ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
1 ^" SEEP PIT(S) CESSPOOLS
IGNATUE
F PERMR
OTTE �_ ------------- -
-•--------------�'i�7�',
76A642D b63 1/53