HomeMy Public PortalAbout5725 LOMA AVE_Sewer__ DEPARTMENT-OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
L?T.V.?SION OF BUILDING AND SAFETY PERMIT APPLICA-TION
COUNTY OF LOS ANGELES
WILLIAM J. FCX, COUNTY ENGINEER BUILDING
ADDRESS _ �•+,� rt' A,
FOR APPLICANJ,0TO FILLINLOCALITY
BUILDING ` � yr/' NEAREST
ADDRESS ry CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST A � r S
CROSS ST.
`RECEIVE"
D/BY/� Ready for Inspection DATE'ISSUEDD
OWNER ✓ l L�/t�/� �// / Y ��/V
es
MAIL USE ZO:N,E/ OCCUPANCY QM%AP-
ADDRESS
BK PG
CITY TEL.NO. ,
CONTRACTORCO.IMP.NO.
ADDRESS _ JOB.N0.
IT-
CITY ar, e. TEL.0
TRUNK PERMIT N0.
QSTATE
REGISTRATION NO. "7 T4.Z'_ dl'o El COUNTY ROAD PERMIT NO.LEGAL
DESCRIPTION LOT NO. PERMIT NOROACHMENT
�
BLOCK TRACT / v� '� - INDUSTRIAL
_ WASTE APPROVAL
SIZE OF LOT NOW ON LOTS j CHARGES/
USE OF
BUILDINGS CONNECTION CHARGE FEE f
NO. DESCRIPTION OF WORK FEE /
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO t�
PUBLIC SEWER CP $ 3.50 7 �� RECEIPT NO. I/ DATE IBY
HOUSESEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR /EXCEPTION RECORDED
WORK TO HOUSE SEWER . 1.00 .
ALTER OR REPAIR EXISTING NO. 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
PITS AND/OR DRAINFIELD 2.00 I STATION ��a Q DEPTH
CESSPOOL—DRYWELL _
SPECIAL CONDITIONS ONLY 2.00 I m MANHOIEEFERENCE�y
di `UPPER�l -LO.W:E,R
TYPEOF-CONNECTION LENGTH FROM
«Y__� ( CURB M.L.TO P.L.
OWNERS PERIvtITY ' $ I I 00 .0- .,.,
AUTHORIZATION ,I TOTAL FEE I 7 -
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED'
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE'
DWELLING TO THE PUBLIC SEWER l
SIGNED THIS--. -----_--.- Y F....... -•.Y`_ NEW HOUSE SEWER
OWNER OR �f CONNECT ADDITIONAL
--------------=-_. BUILDING OR WORK
OWNERS AGENT-
SEPTIC TANK,SEEP.PIT(S)
ADDRESS----------------------------- -------------------- - .---.................... AND/OR DRAtNF1ELD
1 HEREBY ACKNOWLE THAT I HAVE RE HIS APPLI- CESSPOOL E] DRYWELL E3
CAN AND-STATE THAT E ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. I SEWAGE DISPOSAL SYSTEM
I 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 DESCRI RESIDENTIAL PROPERTY. BACKFI LL SEPTIC TANKS
SIGNATURE �
_ SEEP.PIT(S)o CESSPOOLS E]
OFPERMITTEE----- - .... ....................----
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