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HomeMy Public PortalAbout6002 LOMA AVE_Sewer__ 76A 642D'- CE808 - 9/73APPLICATION FOR PERM "COUNTY OF LOS ANGELES•' SEWER—SEWAGE„DISPOSAL. DEPARTMENT'OF COUNTY,ENGINEER BUILDING AND SAFETY DIVISION BUILD'NI ,ADDRELOCALITY SS' C. NEAREST- - FOR APPLICANT TO FELL IN CROS ST:,. �C{ .. LEGAL. c ” :/ DESCRIPTION. LOT NO. - OWNER 'A'�li-A..� -h/.." �'EJ �• .: ' .. �• .MAIL C%y BLOCK TRACT' ...Q - ADDRESS i.^- NO. OF BLDGS. SIZE OF'LOTX /83 'NOW ON.LOT CITY :�'` , !,'/- TEL. NO. .., -USE OF .. - � .... BUILDINGS DISTRICTNO. GROUP. MAP -PROCESSED BY t3. C '. _BK Pa (7 / CONTRACTOR /OL�,d- c�Cm`�'i✓}G � ' �� - ."— �J�ry_ f, ADDRESS `„' - 0 - - CONNECTION-DATA //`� STATIONF DEPTH', .l�.e'•w T.L.TEL. NOr f'1S J��✓ -STATE - LIC - 'MANHOLE REFERENCE / UPPER LICENSE NO:. •-CLASS - 7`•Y- (_/ l/ NO. DESCRfPTION:,OFWORK- FEE ' TYPE OF CONNECTIO _ LENGTH FROM ) HOUSE-SEWER•CONNECTING TO Y. CURB' P.L. M.L.TO,P.L: ` PUBLIC SEWER - �" $7.00 SEPTIC TANK,SEEPAGE PITOR �I P.C. PITS AND/OR DRAINFIELD �. EIO.00 CO.GIMP.-NO` _i/ JOB NO. HOUSE.SEWER CONNECTING TO'. •TRUNK PERMIT O.: ROAD PERMIT.`N O. " PRIVATE DISPOSAL SYSTEM @ S3.00 - CONNECT ADDITIONAL BLDG.'OR AFFIDAVIT WAIVER �EASEMEMT RECORO.ANSTR.NO, WORK TO HOUSE SEWER _, ® "$3.00 - - f1 OVERFLOW SEEPAGE PIT,DRAINFIEL_D V EXT N..CESSPOOL,DRYWEI'L. $5.00 ALTER.RE PAIR OR ABANDON HOUSE - - HWY.OR ST.WIDENING. SEWER OR.DISPOSAL SYSTEM" 53:00 `,STATE ENCROACHMENT, - - U" ` MANHOLE (� $7:00 - PERMIT NO. - _ LAj C_') -INDUSTRIAL d WASTE APPROVAL, ' N Z OWNER'S PERMITSl 0,. CHARGES. CONNECTION CHARGE FEE AUTHOWAnON1 TOTAL.FEE, J 1 HAVE AT THIS DATE A CONTRACT WITH THE HE NAMED CON. REIMBURSEMENT-FEE'TRACTOR TO CONNECT THE ABOVE:DESCRIBED;EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS 'DAY OF - 19_ . - r OWNER OR NEW HOUS_E'SEWER OWNERS AGENT' - - CONNECT ADDITIONAL _ ADDRESS - BUILDING OR WORK - - _ .. ,. SEPTIC TANK,SEEP:PI,T(S) -'' , .. , ' 1 HEREBY"ACKNOWLEDGE THAT I HAVE•READ THIS.APPLICATION AND/OR DRA'INFIELD AND STATE THAT THE„ABOVE,ISCORRECT,AND AGREE,TO COMPLY -, WITH ALL COUNTY ORDINANCES AND STATE LAWS 'REGULATING PLUMBING AND SEWERS. LO OL'❑ 'ORY,WELL ❑I HEREBY CERTIFY THAT I AM PROPERLYREGISTERED AND�OR :REP.AIR,SEWER ORLICENSED .AS REQUIRED BY-LOS- ANGLES COUNTY AND STATE-OF E.D I SPOSA'L,SYSTEM -” .,CALIFC62NIA OR THAT I AM'THE LEGAL OWNER OF, AND INTEND TONECT-PLUG ANDRESIDE IN; THE ABOVE DESCRIBESIDENT.IAL PROPERTY - ON HOUSE SEWERSIGNATURE-OF PERMTTTEE E-�- LL SEPTIC TANKS'❑IT(S)'.❑ C SPOOLS ❑ , •: A DATI rK, M.O. CASH a 3 2` a 5.. va V