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HomeMy Public PortalAbout5630 LOMA AVE_Sewer__ DEPART➢LENT OF COUNTY ENGIYEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT. APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS S6, n r.I ,( r►iii o FO/R APPLIC NT TO�q FILL IN !' LOCALITY T C . ADDRESSBUILDING �(pjo NEAREST CROSS ST. LOCALITY ' - DISTRICT N0. SERIAL N0: PERMIT NO. NEAREST "'T�� r � `` 1t J IA I�(0 7 S CROSS ST. ! T � fie( �+ RECEIVED BY Ready for Inspection DATE ISSUED OWNER ! V U R ! MAIL I�`Y G/��.t_ II-4-s.3 FJ `7 ADDRESS USE ZONE rr OCCUPANCY BK MAP PG CITY TELAO. CONTRACTOR 7 Op, ori 6 ADDRESS n -�-I D _ D r N �J JOB.NO. CITY 1 d' TEL.NO-Ml- �,(j 0 4- YkUNK PERMIT NO. REGISTRATION NO. STATE / � °COUNTY ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. PERMIT NOS BLOCK TRACT _ / / 3 INDUSTRIAL- SIZE OF tOTWASTE APPROVAL,, CHARGES OF BLOTS.�® t G4L NONO.W G © ON LOT � F / USE OF DI I-t I I r ^� I CONNECTION CHARGE FEEX,)/ BUILDINGS �[,/ 1... f`j NO. DESCRIPTION OF WORK FEE /'`l HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE�// I PUBLIC SEWER @ $ 3.50 SO RECEIPT NO. DATE�I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR / EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. I DATE BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR i PITS AND/OR DRAINFIELD 2.00 STATION '��� 2-. DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00. . MANHOL•E-REFERENCE 4.4-� in .>, FLIPPER =VO.W ER- TYPE OF CONNECTION - LENGTH FROM Y- CURB P.L. M.L.TO P.L. �!°7 OWNERS PERMIT $ I 00 AUTHORIZATION I TOTAL FEE 14- 1,270, IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING. APPROVALS INSPECTOR'S SIGNATURE * DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS-.-.__-3. ._...DAY OE.....� �..--_..19�� NEW HOUSE SEWER /�.- �,;r 3 OWNER ORCONNECT ADDITIONAL OWNERS AGENT---------- _ BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS...............-..............-..........-......_....-.-.-...._- _ -... AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1.HAVE READ THIS APPLI- CESSPOOL E] DRYWELL I] 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND DISCONNECT PLUG AND/OR LICENSED AS,REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIF RNIA OR THAT I AM THE LEGAL OWN. ER OF THE ABO .E D SCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ; SEEP.PIT(S)[3 CESSPOOLS SIGNATURE J+� OF PERMITTEE...- - = ^cr f.•�'? - - 76A642A 663 7/53