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Home My Public Portal About5919 LOMA AVE_Sewer__ 7_6A842D - A�PPLlCATl0. V ■ 0R--. E ■.MIT ` COUNTY OF LOS ANGELES: SEWER—SEWAGE.-DISPOSAL ,J', DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION it DRE S JOHN:A. LANIBIE, County Eigineer` DRESS , ! F s��"� CASSATT'D. GRIFFIN,.Sup't of'Building CALITYAREST FOR APPLICANT TO. FILL IN CRosssT:: LEGAL DESCRIPTION LOT N0: OWNER - ' BLOCK TRACT MAIL p © ADDRESS- 6 NO.OF BLDGS. r�•• SIZE OF LOT 0 I -3 NOW ON LOT CITY TEL:NO._ f 6 USE OF DISTRICT N0. GROUP MAP OCESS BY BUILDINGS - _ HK P6 CONTRACTOR •- -I ADDRESS 3�z CONNECTIO DATA CITY TEL.-N0. / ll-'a•3 STATION DEPTH ATE MANHOLE REFERENCE PER REGISTRATION N0. COUNTY „ NO: DESCRIPTION OF WORK FEE _ . HOUSE SEWER CONNECTING TO - PUBLIC,SEWER. $3.00 SEPTIC TANK,SEEPAGE PIT OR TYPE OF C NEC N LENGTH-FROM PITS AND/OR-DRAIN FIELD @ $3.00 Y. UjRB - P.L.. M.L:TO .L. OVERFLOW SEEPAGE PIT, DRAINFIELD - - I EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 /L HOUSE SEWER CONNECTING TO 4P.C,N PRIVATE DISPOSAL SYSTEM •@ $1.00 C .I P.N0. I Z JOB N ` CONNECT ADDITIONAL BLDG.ORTRUNK PERMITINO~' ROAD PERMIT NO. V2 "- WORK TO HOUSE'SEWER @ $1.00' t . +' ALTER,REPAIR OR ABANDON HOUSE - STATE ENCROACHMENT SEWER OR DISPOSAL-SYSTEM @ $ .00 PERMIT,ND`. - INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S I PERMIT S L 2 00 ' CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 0-0 REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS- DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS Ay OF 19 NEW HOUSE SEWER �XC OWNER OR� _ CONNECT ADDITIONAL / /�5 9 OWNERS AGENT � � '� BUILDING OR WORK b SEPTIC TANK,SEEP,PITS) ADDRESS AND/OR DRAINFIELD. - I HEREBY ACKNOWLEDGE THATHAV _READ THIS APPLICAT AND STATE THAT THE ABOVE IS CORRECTAND AGREE TO,COMpfY CESSPOOL❑- DRYWELL❑ 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 LICENSEDAS 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 PERMITE jALMATION ROBERT A.WOOD ' ! M.p, cultSUPrzkvis Q MECHANICAL.ENGINSER L vO'7 5-a o u OU ti 6.G �� u