Loading...
HomeMy Public PortalAbout6157 LOMA AVE_Sewer__ ,• gyvq�. 1 ��pp vp� �yp�� pp.� . ® �+yp 78A8420 ice'\Y e COUNTY:OF LOS:ANGELES SE ' EWAGE ®9SPOSAL, DEPARTMENT; OF•COUNTY.ENGINEER BUILDING AND SAFETY DIVISION naDeEss r JOHN'A. LAMBIE County Engiaeer :.CASSATT D. GRIFFIN Su'p't of Building LOCALITY .No z.t. Z. t FOR APPLICANT'TO FILL IN ceoss sr: /i LEGAL. "DESCRIPTION. LOT'NO., a 11 OWNER /. ''I" l•�ct� � " BLOCK TRACT a fMAIL y`` 'ADDRESS _ o� N0. F BLDGS:... r_ '9r _•.,t - E; _ - - SIZE OF-LO.T;t'3,,4-d0 -_ 'NOWON LOT CITY "-s/ ��^-" TEL. N0. - USE OF, 0 -•,f ( _ .__ - _ BUILDINGS, ¢ I ri -� 2` CT N0. "GROUP _ MAP OCESSED BY' ' i DISTRI BK P6 CONTRACTOR � - ':.�"��' rt...F�' - .• - ADDRESs. 1 G � CONNECTION DATA �cLG'/ CITY TEL.NOi STATION "�" DEPTH f . STATE MANHOLE REFERENCE UPPER- .114. PPER ' REGISTRATION NO: � '1 �i�j COUNTY " t7 "rf '. ' �'�1 �C7� 'COWER: NO. DESCRIPTION OFV K: FEE.'° HOUSE SEWER CONNECTING TO'., PUBLIC SEWER @ $3.00"SEEPAGE PIT OR C�(,d,E.(zTION LENGTH-FROM P PITS AND/OR DRAINFIELD @.,$3:00 .Y... . RB P.Li.. M.L.TO P.L." 7— SEPTIC-TANK, OVERFLOW SEEPAGE PIT, DRAINFIELD EX TN.;CESSPOOL,DRYWELL,MANHOLE.@-$2.00' 'HOUSE`SEWER CONNECTING TO f' ' P.C:N0. PRIVATE'DISPOSAL SYSTEM - @ ,$;1.00 _ CO.'IMP. N0:'[i .JOB NO: ' -. .-CON NECT.ADDITIONAL-BLDG OR TRUNK,PERMIT NO,. -`.-ROAD-PERMIT NO. WORK.TO.-HOUSE SEWER @..$1.00 'ALTER,'REPAIR'OWABANDON HOUSE -•� �- ,'STATE ENCROACHMENT - SEWERORDISP.OSALSYSTEM• •;Q:.$1:00 - PERMIT NO. - - - r.. �. .. INDUSTRIAL `WA:STE;APPROVAL "CHARGES OWNERS` PERMIT, :, ;`;� .2 :00• F CONNECTION CHARGE FEE' AUTHORIZATION TOTAL'F�EE .. '. - REIMBURSEMENT FEE - LI HAVE AT.JHIS"DATE A CONTRACT WITH;THE HEREIN ,NAMED CON APPROVALS , DATE INSPECTOR'S'SIGNATURE ,TRACTOR TO"CONNECT. THE ABOVE DESCRIBED EXISTING,I)WELCING •'TO THE PUBLIC SEW S '/a r r -, }• NEW HOUSE SEWER SIGNED THIS DAY OF 1.9 OWNER OR ;CONNECT,ADDITIONAL' OWNERS AGENT �/� BUILDING OR WORK ADDRESS` SEPTIC'.TANK,SEEP,PIT(S)' e •;AND/OR.DRAI-NFIELD: L HEREBY ACKNOWLEDGE-THAT AI HAVE READ-. IS APPLICATI N ? .AND STATE_THAT THE•ABOVE"-IS CORRECT AND AGREE TO COMP Y CESSPOOL.❑t-DRYWELL❑ ' WITH'ALL COUNTY ORDINANCES "AND STATE.-LAWS-REGULATING .'ALTER,•REPAI*R,SEWER OR.-=; '• "- PLUMBING, AND,SEWERS: , SEWAGE DISPOSAL SYSTEM •.L"HEREBY CERTIFY THA;g I AM„PROP,ERLY ISTERED .AND/,OR i CONNECT PLUG AND, - LICENSED AS REQUIRE Y i0S ANGE ES C NTY AND'STATE.OF ABANDON-HOUSE SEWER '~ ,CALIFORNIA.OR _TH' V"AM THE,LE AL NER OF TH ABOVE DESCRIBED, RESIDENT L PROPERTY _ BACKFILL SEPTIC TANKS❑,`� /� ,fir SEEP PI7(S)',.❑ CESSPOOLS SIGNATURElr.`. : .'�;. �- G�c,til OF PERMITTE "" F / ROBERT A 1NOOD ALZDATIO rd o CASK SUPERVISING MECHANICAL tN6IMEER a k 1 �. s ..