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HomeMy Public PortalAbout5539 LOMA AVE_Sewer__ pip '. ■246504 INpSEERTS,,. �y gp CE808.S;60 �h tl ��I'!�'��J®0 G, FO �Y: 11 E B \.!Y71b�I..� r '`asasazo COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL. ' DEPARTMENT OF COUNTY ENGINEER BUILDINGAND SAFETY DIVISION BUILDING.r-- — -- - ADDRESS ' •k - JOkN'A. LAMBIE, Couiitp Engineer i WILLIAM A. JENSEN, Sup'Y of Building' 'LOCALITY" ' ...NEAREST. FORAT FILL'-IN ceoss sr.. LEGAL - - 1 !OWNER t�� - DESCRIPTION LOT N0. - ; BLOCK" ' . •'TRACT.,.- - - • MAIL- .,.ADDRESS NO.OF BLDGS.�.•- -. - SIZE OF LOT NOW ON LOT CITY - t-. TEL.�'NO. r r `. USE OF .. . .... -. :., „- .BUILDINGS „ - DISTRICT NO. GR MAP •, 'PROCES�,~D BY ,' CONTRACTOR. Of � s . ADDRESS;.. •. _ -� - ., . CONNECTION DATA CITY SEL.N0. - .'STATION• DEPTH - - ` � s -STA E'COUNTY 'MANHOLEREFERENCE C��.�/ . , . ..(. .UPPER-” REGISTRATION•N0. - ND: � .'DESCRIPTION OF WORK. FEE HOUSE SEWER CONNECTING,TO PUBLICSEWER @ $3.00 TYPE OF CONNECTION 'LENGTH FRdM ' SEPTIC TANK, SEEPAGE PIT OR ..Y. CURB -P.L. 'M:L.TO P.L:. P.ITS.AND/OR,DRAI'NFIELD- @ *$3.00 - -OVERFLOW SEEPAGE:PIT;DRAINFIELD srl.reae ' EXTN::CESSPOOL, DRYWECL� @ $2.00' - ' ' HOUSE SEWER CONNECTING TO /'P.C.NO. 73-75 PRIVATEDISPOSALSYSTEM... @ $1:00 . =CO. LM P..NO.,,. - JOB NO. � 3 rk CONNECT ADDITIONAL BLDG,OR ' WORK TO.HOUSE,SEWER @ $1.00=.. TRUNK PERMIT NO. ROAD PERMITNO. .'.- O U ALTER, REPAIR.OR ABANDON HOUSE- 'STATE ENCROACHMENT - - SEWER OR DISPOSAL SYSTEM - _ @ $1.00 PERMIT NO` p •'INDUSTRIAL .. WASTE APPROVAL _ ,a OWNERS PERMIT: $. CHARGES . 2 00 CONNECTION CHARGE FEE- 'AUTHORIZATION TOTAL FEE. REIMBURSEMENT FEE - - -. 1 HAVE AT THJS.DATE A CONTRACT-.WI,TH.THE,_HEREIN .NAMED-CON :. - .TRACTOR, T0, CONNECT,THE ABOVE DESCRIBED EXISTING DWELLING .APPROVALS DATE• •INSPE&O'll"S:SIGNATURE TO THE PUB LIC .SEWER. .. - SIGNED THIS'. AY OF 19_ NEW.HOUSE SEWER r OWNER OR - ' - CONNECT ADDITIONAL - OWNERS AGENT BUILDING OR WO ADDRESS - - I -- SEPTICTANK,SEEP.PIT(S) .; 'AND/OR DRAINFIELD - I HEREBY:ACKNOW-LEDGE.THAT J HAVE READ THIS APPLICATION AND STATE 'THAT _THE'.ABOVE'IS CORRECT AND AGREE TO, COMPLY. CESSPOOL ❑ DRYWELL ❑ - WITH ALL. COUNTY ORDINANCES-'AND'STATE LAWS REGULATING ..ALTER,:REPAIR,-SEWER OR •f PLUMBING AND SEWERS'' `.- SEWAGE DISPOSAL SYSTEM I -HEREBYCERTIFY 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 1 -AM THE .LEGAL.OWNER OF THE ABOVE DESCRIBED RESIDE ALPROPERTY. - I BACKFILLSEPTIC TANKS ❑ SEEP. PIT(S). ❑ CESSPOOLS El. SIGNATURE 'T•.. OF PERMiTTE kffifift ®e` .-. VALIDATIO ROBERT A WOOD ° SUPERVISING MECIiANICALrENGINEER ` ..: 'CK. M.O., CASH_ - } , 24650`INSERTS; `�r� 76A642D CE808,6-60 APPLICATION F®R PERW COUNTY-OF LOS ANGELES SEiAIERSEWAG9 ®ISPOSd L _• Y. DEPARTMENT'OF COUNTY ENGINEER BUILDING_ AND SAFETY DIVISION ' BUILDING '.ADDRESS" - JOHN A. LAMBIE, County Engineer :,. WILLIAM Al-JENSEN, Sup't.of.Building ,LOCALITY ;NEAREST„ -.:„ -:- .,,, ..� .•.! FOR APPLICANT .TO FILL IN -,:. ,CROSS ST: DESCR DESCRIPTION LOTNO.�Q .. . .•LEGAL OWNER •-„- _ BLOCK. TRACT t ! }MAIL _ 'ADDRESS- t ' _ .OF BLDGS. .. , SIZE OF LOT - -NOW ON LOT ',.CITY ;` .- ._TEL..NO.B'USEUILDINGS DISTRICT OF DIS ICT N0.' GRO MAP” PR ES BY BUILDINGS � •_ /� CONTRACTO K G. - ADDRESS '�l' .i CQ NNECTION DATA w CITY • .,... .* EL.NO... 7.. ! 6 :'STATION' ,, .t DEPTH _ �. STATE ;MANHOLE E CE10� - REGISTRATION NO. © / "COUNTY •�� _ i d ,s. " m OWER.2 N DESCRIPTION OF WORK FEE - HOUSE'SEWER CONNECTING TO r� - - ` PUBLIC SEWER @ $3.00 TYPE ,F CONNECTION -LENGTH FROM,' SEPTIC TANK,SEEPAGE PIT OR !Y: CURB P.L. M.L:'T,O P.L. LLa, PITS AND/ORDRAINFIELD •@ $3.00 t 'OVERFLOW SEEPAGE PIT, DRAINF,IELD " y- - EXTN...CESSPOOL DRYWEGL @ $200' - -` HOUSE SEWER CONNECTING T0. `; - P.:C.NO:' �:�-a - PRIVATE DISPOSAL SYSTEM @-$1.00 CO. IMP: N0.- -JOB NOF �.J -CONNECT ADDITIONALBLDG.OR -. - TRUNK PERMIT NO.y: ROAD PERMIT NO. - V WORK TO;HOUSE SEWER @ $1.00 - ALTER, REPAiROR`ABANDONHOUSE - STATE ENCROACHMENT -SEWER OR DISPOSAL SYSTEM. @ $1.00..- :PERMIT NO. - p .INDUSTRIAL., F WASTE APPROVALa- .-; .CHARGES - OWNER'S PERMIT,. $ Z QQ• CONNECTION'CHARGE FEE AUTHORIZATION TOTAL•FEE REIMBURSEMENT FEE ` 'IHAVE 'AT THIS DATE. A CONTRACT.WITH,THE HEREIN NAMED,-CON-- - - - - - TRACTOR.TO CONNECT THE.`ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE a INSPECTOR'S.SIGNATURE .TO THE PUBLIC SEWER, - SIGNED THIS ', D Y OF I9 " NEW.HousE'sEwER 'u `CONNECT ADDITIONAL OWNER OR - = - - OWNERS AGENT ''�p ..BUILDING OR WORK.-- - / - SEPTIC.TANK,SEEP.PIT,(S) - - .ADDRESS' - AND/OR-0 INFIELD. - *'•� . -, ._.. A HEREBY�ACKNOWLEDGE THAT'I HAVE READ-THIS'- APPLICATION— AND, STATE THAT THE :ABOVE'AS CORRECT AND�AGREE. TO COMPLY CESSPOOL-❑ DRYWELC"❑ - WITH FALL COUNTY ORDINANCES AND STATE­LAWS,LAWS, REGULATING ALTER,REPAIR,SEWER OR _ PLUMBING AND SEWERS.. - - "y HEREBY CERTIFY,THAT I'AM PROPERLY :REGISTERED AND/OR. 'SEWAGE.DISPOSAL SYSTEM`_' LICENSED AS REQUIRED'BY,LOS ANGELES COUNTY AND STATE OF' . DISCONNECT.'PLUG AND CALIFORNIA' OR'..THAT l AM.THE LEGAL OWNER-OF.THE,,ABOVE ABANDON HOUSE SEWER " ' _ DESCRIBED RESIDENT L PROPS Y. - BACKFILL,SEPTIC TANKS ❑' -.SEEP.PIT(S):.E1 CESSPOOLS-❑ --" SIGNATURE •.'..' "� -. 'OF PERMITTEE OF VALIDATIO ROBERT A WOOD cK. M.o,_ CASH SUPERVISING MECHANICAL ENGINEER _ ! '2///�,p��{•.j G q Aim/