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Home My Public Portal About5930 LOMA AVE_Sewer__ 76A 642D-CE 808A-7,76 APLICA4T1 N FOR PERM SEWER—SEWAGE DISPOSAL COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN DISTRICT NO. GROUP SK MAP �Pa ROC SED BY BUILDING kc)-mc.— ;O x �� / , ADDRESS V {+J�-O Y�(�- C„ �� ((1J / CONNECTION DAT LOCALIT JJ A Al NEAREST STATION DEPTH CROSS ST. / UPPER MANHOLE REFERENCE // / /A/ --- OWNER TYPE OF I N T LENGTH FROM MAIL / Y. CURB P.L. M.L.TO P.L. ADDRESS ,l` P.C.NO. CITY -TEL. NO. l� CO.IMP. NO. JOB NO. LEGA TRUNK PERMIT NO. ROAD PERMIT NO. DESCRIPTION LOT NO. 23 AFFIDAVIT I WAIVER [ASEMENV RECORD.INSTR.NO. DATE BLOCK TRACT Ivo Y: /� �J NO. OF LDGS. •� (J..�/ SIZE OF LOT 0 X. 3 NOW ON LOT HWY.OR ST.WIDENING /- L _Y USE OF STATE ENCROACHMENT ✓u BUILDINGS PERMIT NO. CONTRACTOR INDUSTRIAL WASTE APPROVAL ADDRESS CHARGES 0 CONNECTION CHARGE FEE CITY TEL. NO. STATE LIC REIMBURSEMENT FEE LICENSE NO. CLASS NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE !� PUSEWER HOUSE BL C CONNECTING TO SEPTIC TANK.SEEPAGE PIT OR NEW HOUSE SEWER PITS AND/OR DRAINFIELD @ CONNECT ADDITIONAL �^ HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM @ 1 SEPTIC TANK.SEEP,PIT(S) CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD SO HOUSE SEWER Vh @ 1, OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL Cl DRYWELL ❑ E XTN..CESSPOOL.DRYW ELL.MANHOLE ALTER,REPAIR OR ABANDON HOUSE ALTER.REPAIR,SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS ❑ SEEP.PIT(s) ❑ CESSPOOLS ❑ OWNER'S Issuance Fee s 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AUTHORIZATION TOTAL FEE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON- PLUMBING AND SEWERS. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR TO THE PUBLIC SEWER. LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SIGNED THIS , DAY O 19_ CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO OWNER OR �} ^ RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. OWNERS AGE TC 6 lCle)/YL_/CC-� ✓ J`La SIGNATURE OF PERMITTEE VALIDATIO CK. M.O. CASH 1 i-XPR 27 -1 ,0. U r CEt106 f 7.6A642D 0-63 APPLICATION[ FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FA.'.IE JOHN A. LAMBIE, County Engineer c' WILLIAM A. JENSEN, Supt of Building ��L FOR APPLICANT TO FILL IN Ale LEGAL DESCRIPTION LOT NO. (f' - OWNER v MAIL BLOCK TRACT � � ADDRESS '\ NO. OF BLD GS SIZE. OF LOT- NOW ON LOT CITY TEL. NO) USE i DISTRICT NO. GROUP MAP �.CiZMD BUILDINGS �a Q BK P CONTRACTOR ADDRESS 3 �a p• CONNECTION DATA CITY TEL. NO.2 g_j 72 0 /` STATION . / // DEPTH ' f / g STATE MANHOLE REFERENCE / REGISTRATION-NO. 6 ❑ �7a*wx / d LOWER NO. DESCRIPTION OF WORK FEETYPE OF ION LENGTH FRO / fr HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 P.C.NO. d SEPTIC TANK,SEEPAGE PIT OR ,IDB NO O PITS AND/OR DRAINFIELD @ SIO.00 CO.IMP.NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT V PRIVATE DISPOSAL SYSTEM @ S3.00 I= e CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE O WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD V U EXTN.,CESSPOOL,DRYWELL,MA NH OLE @ S5.00 UjUj ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING h SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT Z PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. /' DATE INSPECTOR'S SIGNATURE SIGNED THIS AY OF- A• 1s�.S q. OWNER ORNEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL V BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE R 7��/p��a�Ij��/A7�N AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND REeT�'�C O•M PLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM. PROPERLY R STERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRE L05 ANG CO NTY,�A NO STATE F SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT THE LEGA O N OFA D INTE TO DISCONNECT PLUG AND RESIDE IN, THE ABO DESCRIBED 'R SI N IAL P TY. ABANDON HOUSE SEWER SIGNATURE OF PERMIT T _ BACKFILL SEPTIC TANKS A� SEEP.PIT' ❑ CESSPO // ❑OLO 04 � M. ,01 0. f ✓ ROBERT°A. WOOD SUPERVISING MECHANICAL ENGINEER M.O. CASH LUcJ97443 JN121 0 .0 7.GC>N