HomeMy Public PortalAbout5717 LOMA AVE_Sewer__ S&E E D 12.S4 A■ fi L I C A T I O tl',T®C Y PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE-DISPOSAL
Deportment of County Engineer Mae
County of Los..Angeles BUILDING
WM. J.FOX, COUNTY ENGINEER ADDRESS /
CASSATT'D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL, IN NEAREST'
I, CROSS ST.
LEGAL - /Q ,/
DESCRIPTION LOT N0. (�e4 OWNER
BLOCK TRACT - �} 7 —7 ADDRESS MAIL -�r7 J '7
—SIZE OF LOT NO. OF BLDGS. - - �y �p
NOVJ ON LOT CITY �- TEL. NOd-r 1414 1
USE OF �¢
BUILDINGS DISTRICT NO. I GROUP I MAP
�° /^�- BK PG
CONTRACTOR
rA'�''.rr�'h.. a+'-• �,. °°�„
ADDRESS y / - C, CONNECTION DATA -
CITY„ TEL. NO. �,:® ^ `6s .: STATION 0+.0 7A DEPTH
/ � ❑ STATE a+=p,�/ @ .fir.. MAN HREFERENCE LOWER
REGISTRATION NO. ❑ COUNTY /P-T__ - �i�
_ - 'TYP=C.
�6' VECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE b Y. 6.CURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO y�
PUBLIC SEWER- - Cn_� $
HOUSE SEWER CONNECTING TO - -
P RIVATE DISPOSAL.SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP..NO. , � JOB: N0.
WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING
_ .SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT 140. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR CISPOSAL SYSTEM 1.00 PERMiT NO.
SEPTIC TANK, SEEPAGE PIT OR -
PITS AND/OR DP,AINFIELD 2.00 "I INDUSTRIAL
CESSPOOL- DRYWELL ` WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
• CONNECTION CHARGE FEE
OWNERS PERMIT 3 1 00
AUTHORIZATION TOTAL FEES REIMBURSEMENT FEE
IHAVE TRACTOR TO DATE CONNECT THECTEDABOVEyVDESCRIBED EXISITH. THE TJINGA D�EELLIO G APPROVALS DATE INSPECTORS SIGNATURE
TO.THE PUBLIC SEWER
SIGNED THIS DAY OF 19 NEw HOUSE SEWER a leo S F�1,Qr'4AA ft ,� l
OWNER -OR p - -CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
-
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ _
-AND STATE THAT THE ABOVE--IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE-DISPOSAL.SYSTEM
1HEREBY CERTIFY THAT 1 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 RESIDENTIAL PROPERTY. -BACKFILL SEPTIC TANKS❑ -
'SEEP:PIT(S) ❑ CESSPOOLS❑.
SIGNATURE.
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY aoO 5' SYS: FES!.1-5
DEPUTY - - DEPUTY
`.BY BY' -
;'°® - DEPUTY DEPUTY. '