HomeMy Public PortalAbout6037 LOMA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
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DESCRIPTION LOT NO. STATE ENCROACHMENT
.! -TT/ PERMIT NO.
BLOCK TRACT ® WASTE APPROVAL
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SIZE OF LUT ®'y g NO
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NO. DESCRIPTION OF WORK FEE I
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEW ER C S 3.50_ tJ RECEIPT NO. ( `DATE BY
HOUSE SEWER CONNECTING TO J
PRIVATE DISPOSAL SYSTEM 1.00 ,
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION ��•�t/p (� DEPTH 6j
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 2.00 T� M1M NHO ERREFERENCE _L
TYPE OF/CONNECTION LENGTH FROM
OWNERS PERMIT ; CURBVb` Q:L:L M11.L.TO P.L.
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AUTHORIZATION I TOTAL FEE h'�
CONTRACTORHAVE
TO CONNECT DATE THEED TOABOVE DESCRIBED WITH THE HEREI
SCRIBEDI EXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER -
SIGNED THIS_--_�. .__.._DAY OF.__. :_ -___..______—___-19 NEW HousE;SEwEll b r-CUG
OWNER OR ./� _ --- - Y CONNECT ADDITIONAL
OWNERS; AGENT. ! _ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS --.--__-_...__-..._._ ... _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOUSE-SEWER PLUG PLUGAND
AND STATE OF CA ORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVA'JDESCRIBEO RESIDENTIAL P OP RTY. BACKFILL SEPTIC TANKS❑ l�
y SEEP.PIT(S)Ej CESSPOOLSf��1}��- jrF �
SIGNATURE
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OF PERMITTEE ---=------...------------•----..............................................
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