HomeMy Public PortalAbout6117 LOMA AVE_Sewer__ •7!'8088.80
78A842D 3'x\8 NATION
R PERMIT. -
COUNTY OF LOS ANGELES' SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS,
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. J_e ,
LEGAL
DESCRIPTION LOT NO. OWNER 1
BLOCK TRACT /7 MAIL p
G' ADDRESS C�'t.✓` r
NO OP BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO
BUSE DISTRICT NO. GROUP BK PG MAP PROCESS BY
UILDIDINGS -
f
CONTRACTOR D 7�
ADDRESS 1 CONNECTION DATA "
CITY TEL NO. 2 STATION DEPTH
STATE MANHOLE REFERENCE -UPPER
REGISTRATI N0. 4w COUNTY LOWER
NO. DESCRIPTIONICIF WORK FEE ��j
HOUSE SEWER CONNECTING TO Q
PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,
PITS AND/OR DRAENFGELDT OR @ $3 00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT NO. ROAD PERMIT NO. p
WORK TO HOUSE SEWER @ $1 00 V
SEWER'OR DAISPOSAL SYSTEM HOUSE @ g1 00 STATE ENCROACHMENT ly
PERMIT NO 0
INDUSTRIAL -V
WASTE APPROVAL W
CHARGES N
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 4!Z7 REIMBURSEMENT FEE -
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED,CON- _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE/ INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19- NEW HOUSE SEWER- 9 /
OWNER OR CONNECT ADDITIONAL /
OWNERS AGENT BUILDING OR WORK
ADDRESS" SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LA ULATING
' ALTER,REPAIR,SEWER OR
E
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY TH AM P LY EGISTERED AND/OR DISCONNECT
LICENSED AS REQUIRE LOS A ELES CO NTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THA M THE lGAL OW R OF ABO ABANDON HOUSE SEWER
DESCRIBED R IDE PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE� SEEP.PIT(S) ElCESSPOOLS 11
OF PERMI warm
®� TIO ROBERT A. WOOD "
CIL !d.0 CASH SUPERVISING MECHANICAL ENGINEER
d LAlLjG9 3 2 4 u MAR 8 1 0 o ` 3.G Q
FOR -PERMIT
•6&E•663 12.54 APPLICATION . 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL'
Deportment of County Engineer IM-Mm" sm
County of Los Angeles
WM. J. FOX, COUNTY ENGINEER
CA65ATT D. GRIFFIN, SUPT OF BUILDINGJ7L
G� F
FOR APPLICANT TO FILL IN NEARESTLEGAL q�� CROSS ST.
DESCRIPTION LOT N0. L OWNERBLOCK TRACT MAIL
ADDRESS if.
NO OF BLDGS.
SIZE OF LOT ® NOW ON LOT CITY TEL. N0. ,=a •�(' O�
USE OF
BUILDINGS Ile DISTRICT NO. GROUP MAP
CONTRACTO ( I /_7� ,G�j'
ADDRESS ��pp 111 - CONNE•,CJTION DATA J
CITY TEL. NO A -('P',.TxSTATION DEPTH
❑ STATE
MANHOLEUPPERLOWER REFERENCE
REGISTRATION N0. A
TYPE 0 CO ECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE Y UR P L M L.TO P L.
HOUSE SEWER CONNECTING TO
_ -PUBLIC SEWER Q $ 3 50 111
hOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR
f 00 CO. IMP N0. JOB.
F-
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO, ROAD PERMIT N0.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1 00 - PERMIT NO
SEPTIC TANK,SEEPAGE PI f OR
ITS PND/OR DRAINFIELD 2 00 INDUSTRIAL -
CESSPOOL- DRYWELL WASTE APPROVAL
_ SPECIAL CONDITIONS ONLY 2 00 CHA ES
CONNE ION CHARGE FEE
OWNER'S ERM[IT s 00
AUTHORIZATION I TOTAL FEE/ REIMBURSEMENT FEE
TRACTORHAVE TO CONNECTDATE ONTRTHEA ABOVE BEDITH THE HEREIEXISTINGA DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR -CONNECT ADDITIONAL
Z
OWNERS AGENT BUILDING OR WORK � -SO (%' .✓ �{
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWCLL❑
AND'STATE THAT THE ABOVE IS 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 Y LOS GELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT t AM T LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PROP TY. BACKFILL SEPTIC TANKS El
SEEP. PIT(.) ❑ CESSPOOLS-
SIGNATURE -
OF PERMITTE -
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
''BY761 6 8 CLEC 310 A 3.0 0 M
DEPUTY DEPUTY
BY BY
® DEPUTY a •��EPUTY