HomeMy Public PortalAbout6132 LOMA AVE_Sewer__ E808 D 11-57-a�
Cfieoe APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
SEWER—SEWAGE ,DtSPOSAL
DEPARTMENT OF COUNTY ENGINEER~
BUILDING AND SAFETY DIVISION BUILDING: +
JOHN A. LAMBIE, County En weer 'ADDRESS -
CASSATT D. GRIFFIN, Sup t of Building LOCALITY I
NEAREST
FO APPLICANT TO FILL IN 'CROSSST 'LEGAL DESCRIPTION LOT N0. OWNERBLOCK TRACT MAIL - rADDRESS !NO OF BLDGS. _
SIZE OF LOT' NOW ON LOT CITY L.N0.'' i
USE OF p�
BUILDINGS .1�/ DISTRICT - GROUP MAP
CONTRACTOR _ - 1 PG
ADDRESS - f '- , CONNECTION DATA
1, >
CITY - EL - STATION /, DEPTH
❑ STATE MANHOLE R FERENCE S UPPER
REGISTRATION N tJ�G(;7 ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $36b
{ SEPTIC TANK,SEEPAGE PIT OR } TYPE OF ION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y. RB P.L. M L TO P.L. O
OVERFLOW SEEPAGE PIT,DRAINFIELD f
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P,C,N0.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO.IMP.NO. jj 9 JOB N0,
CONNECT ADDITIONAL BLDG.OR '
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT -
PERMIT NO
INDUSTRIAL -
WASTE APPROVAL -
i CHARGES
OWNERS PERMIT g 00 CONNECTION CHARGE FEE_
AUTHORIZATION TOTAL FEE DO REIMBURSEMENT FEEHAVE AT /j
TR CTOR TO CIONNECT THE ABOVE ES RIBED EXS-DATE A-CONTRACT WITH THE- ISTING DWELLING APPROVALS t DATE INSPECTOR'S SIGNATURE -
TO THE PUBLIC SEW __ _ _ __ _ __ y _-
SIGNED'THIS _ DA F 19 NEW HOUSE SEWER �j�► j ��
OWNER OR •�/' Se- - s— •CONNECT ADDITIONAL- --"' T•--"*
OWNERS AGENT BUILDING OR WORK
ADDRESS" - _ -SEPTIC-TANK,SEEP,-PIP(S)-_1- ----- — _'-•-.------ :-•
`AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ..� ...+ �, ..,�"�
AND STATE THAT_THE ABOVE IS CORRECT AND AGREE-TO.COMPLY - --CESSPOOL-El DRY-WELL'El ---• - .... ___-_
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
IHEREBY CERTIFY THAT' I'AM PROPERLY-REGISTERED'ANb/OR- SEWAGE DISPOSAL SYSTEM-
LIC ENSED
YSTEM-LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR _TH/_T_-I.-AM THE .LEG L OWNER- OF-THE-ABOVE. ABANDON HOUSE SEWER
DESCRIBED RESIDEN a-PRO ERTY ` BACKFILL SEPTIC TANKS ❑ -
/ SEEP. PIT(S) El CESSPOOLS ElSIGNATURE- _ _ � _ _.., ..-
OF PERMITTE -
®r VALIDATI _ ROBERT-A.WOOD
cK� et,o. GASB SUPERVISING MECHANICAL ENGINEER
6 9-8 5 +". 25-1 E)--A-
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