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Home My Public Portal About6156 LOMA AVE_Sewer__ D S E-689 11.33 APPLICATION- FOR PERMIT _ 1 8&E-8 . ;DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County,Engineer County of Los Angeles ' BUILDING /� %' - ' JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS f / ® CASSATT D GRIFFIN, SUPT of BUILDING LOCALITY OR APPLICANT TO FILL IN CROSS sT. LEGAL OWNER DESCRIPTION LOT NO. MAIL J BLOCK TRACT D ADDRESS (,/NO. OF BLDGS. A CITY �(r TEL. NO /- SIZE OF LOT NOW ON LOT i USOF BUILDINGS 1 DISTRICT IrO. GROUP MAP B PG CONTRACTOR -n!^"' ADDRESS CONNECTION DATA - / '!) 7� �D STATION r 4 0 EPTH CITY TEL. NO. �J' MANHOLE REFERENCE UP ❑ STATE OWER REGISTRATION NO. 19'If ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO a) TYPE OFC TION LENGTH FROM PUBLIC SEWER @ $3.50 v Y. RB P.L. M.L. TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 - OVERFLOW SEEPAGE PIT,DRAINFIELD ' P. '. No. , EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. ��,.,� JOB N0. HOUSE SEWER CONNECTING TO Gid Q 0_� _ PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. q� �/ CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE-SEWER @ $1.00PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM .Q $1.00 WASTE APPROVAL CHARGES ]-�)CONNECTION CHARGE FEE ' - OWNER'S PERMT $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE. I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR APPROVALS DATE INSPECTOR'SSI'GNATURE TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER _ /9 _ SIGNED THIS Y OF 19 CONNECT ADDITIONAL / v OWNER OR / BUILDING OR-WORK OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) ' ADDRESS 6 t AND/OR DRAINFIELD - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ 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 I 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 OWNER OF THE ABOVE DESCRIBED RESIDENTIA P. OPERTY. BACKFILL SEPTIC TANKS❑ SEEP.PIT(S) [ICESSPOOLS �/�� %9�� ,rL SIGNATURE �s-•�'` _ OF PERMITTEE / JOHN'A. LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT A. WOOD, CHIEF PLBG:,INSPECTOR' CK. M.O. x':00 322u; JUL 17 4 5' 50 L �:r�yjit. -24650 IN CE9096.80 ��A l0N T R PERMI •-_ 76ne42n COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL �. DEPARTMENT'OF COUNTY ENGINEER BUILDING AND SAFETY DMSION 7- U JOHN A. LAMBIE,.County En 'neerWILLIAM A. JENSEN, Supt of Bulding NEARESTFOR APPLICANT TO FILL IN CRO[ADDRESS L "OWNER ION LOT NO.TRACT MAILADDRESS NO.OF BLDGS.OT NOW ON LOT TLiL. N0. + DI*STRICT N GIRO MAP PROCESSED BY S q r1 BK PG TOR (XJ ' ' . -� CONNECTION DATATEL.N0. 3�� STATION .t Q DEPTH STATE MANHOLE REFERENCETION NO. / COUNTY OWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO - .PUBLIC SEWER @ $3.00 TYPE OF CONN NLENGTH FROM, - SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L.- -M'.L.TO,P.L:'*. }- ' ITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD - EXTN .CESSPOOL DRYWELL @ $2.00HOUSE p•.C.N0. PRIVATE DVER ISPOSAL SYSTEM TING O @ $1.00 CO IMP. N0. ,',tt� )� JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT RNOA ROAD PERMIT-NO. t0 WORK TO HOUSE SEWER @ $1.00 _,•gyp ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT •' t;y�•�t SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. .is •h� O INDUSTRIAL _ , '•` WASTE APPROVAL W• • CHARGES OWNER'S PERMIT S 2 ,00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL: FEE 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 OWNER OR - CONNECT ADDITIONAL OWNERSAGENT _ BUILDING OR WORK <' ADDRESS SEPTIC TANK,SEEP,PITS) 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 LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRE Y LOS-,ANGELES_COUNTY AND STATE OF ABANDON HOUSE SEWER - - - CALIFORNIA OR THA 1 AM THE EGAL R SOF THE ABOVE - DESCRIBED RESIDEN A PR(TPERT BACKFILL SEPTIC TANKS ❑ _ SEEP.PIT(S) []-CESSPOOLS ❑ ' SIGNATURE OF PERMITTEE - ®r VALIDATION ROBERT A. WOOD cK. M.0. CASH_ SUPERVISING MECHANICAL ENGINEER- 0 1 7 i J� 18 0 3 .0 0. ID _ 1. _° l -/ 76A°6420 68 APPLOCATOON FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL ' DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FN ILDING �C./ ! A r JOHN A. LAMBIE. COUNTY ENGINEER DREse l O/ COLEMAN W. JENKINS. SUPT. OF BUILDING CALITY / C� ARESTFOR APPLICANT TO FILL IN OSS ST. LEGAL DESCRIPTION LOT NO �,. �p 4 OWNER C11 L - MAIL BLOCK TRACT {{��' [J ¢- ADDRESS f SIZE OF LOT t) X I /�N OWOON LOTS CITY G I TEL. NO. ti r USE OFA 47&-51BUIUSE INGS DISTRICT NO. GROUP MAP PROC7L...R o A / �• BK PG CONTRACTOR U)I 9-)et A PE-A Sb if D •/ -_�ADDRESS � (,� C CO ECTIO DATA CITY �•-0 TEL. NO. .�S STATION DEPTH STATEL'C' ! �( }) fCASS MAN LE REFERENCE LICENSE NO GAJ 'T' N d NO DESCRIPTION OF WORK FEE TYP F CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P.L M.L TOP L PUBLIC SEWER $5 00 SEPTIC TANK.SEEPAGE PIT ORP.0 NO. PITS AND/OR DRAINFIELD � $1000 CO IMP. NO JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $300 CL O CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVII I EAS! t RECORD INSTR NODATE U WORK TO HOUSE SEWER Q $3.00 OVERFLOW SEEPAGE PIT DRAINFIELD Q EXTN CESSPOOL DRYWELL MANHOLE Q $5 00 H. HWY OR ST WIDENING ALTER. HOUSE 0-6 W SEWER O STATE ENCROACHMENT PERMIT NO C/J INDUSTRIAL WASTE APPROVAL OWNERSI PERMR s 21 00 CHARGES AUTHORIZATION TOTAL FEE6-D CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO_CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNA URE SIGNED THIS DAY OF 1g_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP,PIT(5) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS G L ❑ DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER, PAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF E DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED PROPERTY. ABANDON HOUSE SEWER SIGNATURE A / BACKFILL SEPTIC TANKS ❑OF PERMITTEE '❑ SEEP.PIT(S) ❑ CESSPOOLS �IJDATION JACK R. ALLENM.O CASHSUPERVISING MECHANICAL ENGINEER 16 1 D 5.001,