HomeMy Public PortalAbout6020 LOMA AVE_Sewer__ S&E-6833 11.55 -A.PPLICATION� FOR PERMIT
3&E-8 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL $
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS. •Q U� ,.�� '
® CASSATT D. GRIFFIN, SUPT oF•BUILDING ILOCALITY
FOR APPLICANT TO FILL IN ' ceoss sT. 67
LEGAL . -, ��V . OWNER
DESCRIPTION LOT NO.. 3 �Q
MAIL
BLO„CK TRACT ' - ADDRESS �j Q �"' � '
NO. OF BLDGS. 02
.CITY TEL. NO.
SIZE OF LO NOW ON LOT f
USE OF DISTRICT NO. GROUP MAP
BUILDINGS
BK PG
CONTRACTORo
�. ) CONNECTION DATA
ADDRESS •. W ; '�(,�, 'STATION . 4. 47-3 d DEPTH
CITY �a� TEL. NO. 1z .�d
1j �'7 MANHOLE REFERENCE
�//y ,��y��D�^'- _
l...�J Co�J.`��'� ❑ S� i6r- 6r` `� :LOWER .
REGISTRATION NO. -NO. DESCRIPTION OF WORK_ FEE -
TYPE 0� @ 'ION LENGTH FROM
HOUSE SEWER CONNECTING TO P.L. M.L.TO P.L.
-.� ..
PUBLIC SEWER @ $3.50 Y. CURB
' 9
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/ORDRAINFIELD @- $3.00 -
OVERFLOW SEEPAGE.PIT;DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL,M AN HOLE n $ 2.00 CO. IMP.-NO. JOB NO. '
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM a $1.00. TRUNK PERMIT NO. ROAD PERMIT•NO. .
CONNECT ADDITIONALBLDG.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
R CONNECTION CHARGE FEE - -•
OWNER'S . PERMIT . $' 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT EEE
I HAVE AT THIS DATE'•A CONTRACT WITH THE HEREIN NAMED-CON- APPROVALS DATE 9NSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED'EXISTING' DWELLING v
TO THE PUBLIC SEWER.. - _NEW HOUSE SEWER'
SIGNED THIS DAY OF •�� 19 CONNECT ADDITIONAL
OWNER OR ° BUILDING OR WORK
OWNERS A NT _z A - -
SEPTIC TANK,.SEEP,-PIT(S)
,ADDRESS OIL-Jo AND
DRAINFIELD - - - ,
1 HEREBY ACKNOWLEDGE .THAT .I HAVE READ THIS APPLICATION CESSPOOL❑. DRYWELL❑ - --
AND STATE THAT THE ABOVE 15 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND,STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL DANE OF THE- ABOVE -
DESCRIBED.RESIDENTIA PROP T BACKFILL SEPTIC TANKS❑
�^ f SEEP.PIT(S).❑'CESSPOOLS
SIGNATURE '
OF PERM ITTE - '
JOHN A. LAMBIE, COUNTY ENGINES VALIDATION ROBERT A. WOOD, CHIEF PLBG..INSPECTOR
. - CK. '. N. 0... CASH __. .. .. -.
41 v Po• -3 :U— APR I2 -4 4.5 0