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Home My Public Portal About5753 LOMA AVE_Sewer__ S 8 E-663 11.55 APPLICATION FORRERMIT . DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE -DISPOSAL Department of County Engineer County of Los Angeles BUILDINGS JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY 9 F" �l FOR APPLICANT TO FILL IN CROSS ST. .. LEGAL - - - OWNER �.• /�{/%�;'.("/'�"''%� DESCRIPTION LOT N0. / MAIL _ BLOCK TRACT % � � ADDRESS - .✓, N0. OF SLOGS. CITY TEL. N0. SIZE OF LOT-5 X•� ,� NOW ON LOT - USE OF. - - O.`! DISTRICT NGROUP MAP BUILDINGS /C -�- - ✓:-� 7 Cil' BK PG CONTRACTOR'S I_ / y CONNECTION DATA < ADDRESS r� �.J... CITY .� TEL. N0. STATION J / - DEPTH Gam' ✓ f �� ' ii MANHOLE REFERENCE UPPER ©'STATE O REGISTRATION NO. �} ❑ COUNTY NO. DESCRIPTION OF WORK FEE TYPE OFCTION LENGTH FROM / HOUSE SEWER CONNECTING TO '`+ �..-_ -Y- C R P.L. M.L. TO P.L. PUBLIC SEWER @ $3.50 d SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP, NO. 10B NO. - O !J V HOUSE SEWER CONNECTING TO " PRIVATE DISPOSAL SYSTEM @ $1.00 .TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL - SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ t 00 REIMBURSEMENT FEE AUTHORIZATION . TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE .HEREIN NAMED CON- APPROVALS DATE _ INSPE :S SANATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. - NEW HOUSE SEWER•_ �� i, SIGNED THIS �. •- �J DAY OF ✓r-�-�/ �g�^' CONNECT ADDITIONAL _ OWNER OR- /� f j BUILDING OR WORK OWNERS AGENT lG' •l l/ %�-�/�J /�.✓, SEPTIC TANK,SEEP, PIT(S) - .ADDRESS � ��- /�/0 ��✓��r '1�'�-^ AND/OR DRAINFIELD - 1 HEREBY A KNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ' CESSPOOL❑ -DRYW ELL❑ 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 I HEREBY CERTIFY THAT I- AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HO PLUGAUSE D CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _. .,.DESCRIBED RES IDENTI PROPERTY. %� BACKFILL SEPTIC TANKS❑ SIGNATURE ,/PR �/' SEEP.PIT(S) ❑ CESSPOOLS QK - - OFPERMITTEE �� / �� - JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. EI.0. LACo 5 15 7°° SEP 2 4 1 A 4.5 0, �