HomeMy Public PortalAbout6153 LOMA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER ( SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY 4 PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING -,%.nADDRESS 3
F ,BUILDING R APPLI N - O FIU14M LOCALITY
ADDRESS 9 j '• NEAREST / 8 e 72
CROSS ST. ( p�
LOCALITY DISTRICT NO. A A SERIAL N0. ERMIT NO. C
NEAREST ! l /j :2S
CROSS Ready for Inspection D ATE IS UED
OWNER r�l/j(eL 1
MAIL USE ZONE OCCUPANCY MAP
ADDRESS r
BK PG_
CITT L.NO. �
CONTRACTO
CO.IMP.NO.
ADDRESS JOB.NO.
CITY TELAO. TRUNK PERMIT NO.
®
STATE
REGISTRATIO N0. COUNTY ROAD PERMIT NO. 2 S Q
LEGAL
J
DESCRIPTION LOT NO. d f ` s�/ STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT 6 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT SId X NO.Of NOW ON LOTS
CHARGES
USE OF B� CONNECTION CHARGE FEE
BUILDINGS �syCl_-_
NO. DESCRIPTION OF WORK FEE
t
-' -- - HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE'�
PUBLIC SEWER 0 S 3.50 RECEIPT NO. _ bATE,-,._.o__ BY
HOUSE SEWER CONNECTING TO 6 "'
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. ))&TE------ .BY
SEWER OR DISPOSAL SYSTEM 1.00 I II
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION + 9 A S_ DEPTH 6 �
CESSPOOL—DRYWELL ff OLE RETp�R N ,�((��
SPECIAL CONDITIONS ONLY 2.00 I OLE P �j /ri LOWER
TYPE OF CONNECTION Y{ LENGTH FROM n /
OWNERS PERMIT ; I 1 CURB mr+L.� M.L.TO P.L. �L
AUTHORIZATION TOTAL FEE � d
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED.;
CONTRACTOR TO"CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.-- - ""_
---•-- ...- DAY OF................ . I
OWNER OR
OWNERS AGENT.-.-_�.L_Ss._.._.. (![//[-C_ ____ ---- __•.._y BU"LDINGORDWORKAL
11 P ISEPTIC TANK,SEEP.PIT(S)
ADDRESS....................---_------------------------ ......................... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- ; CESSPOOL[:] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE;
TO COMPLY WITH-ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING.PL•UMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM -
1 HEREBY CERTIFY'•THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED"AS REQUIRED BY LOS ANGELES COUNTY- ABANDON HOUSE SEWER
AND STATE"OF_'=CALIFORNIA OR THAT I AM THE LEGAL OWN- -
ER OF THE ABOVEIDESCRIBEDESIDENTIAL PROPERTY. i BACKFILL SEPTIC TANKS 0
SIGNATURE
I SEEP PIT(S)[-] CESSPOOLS
r OF PERMITTEE --�---------- ^- ---------••---------
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