HomeMy Public PortalAbout6206 - 6208 LOMA AVE_Sewer__ ` "10it)EPARTMENT OF COUNTY ENGINEER C SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
7 COUNTY OF LOS ANGELES S
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS X
FOR APPLICANT FILL IN LOCALITY :7em
BUILDINGNEARE / / I
ADDRESS CROSS ST.ST G�1/i(�C�IQ1/ �(pft�/0144/�w
LOCALITY D, n DISTRICT NO. SERIAL NO.. PERMIT N0; c
NEAREST /� /K 1' #/76,5-1(5-
/(p 5 7,�1 JZO J
CROSS ST.-�J(7 /`/ ay C// � RECEIVED BY Ready for Inspection-. DATE ISSUED
O W N E R &d(/ .- '
MAIL rp- USE ZONE OCCUPANCY BK MAP PG
ADDRESS �ayrJ�
CITYTEL,NO.
CONTRACTOR Q. C��.�
�} CO.IMP.N0.
ADDRESS 11/G 1,31 �Y
JOB.N 0.
CITYeaW " iTEL,NO. / TRUNK PERMIT N0.
❑ STATE , t
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION !OT NO. / J � n J1 STATE ENCROACHMENT
La p[L/7Yij ,C( PERMIT NO.
BLOCK TRACTINDUSTRIAL
1 WASTE APPROVAL '-"'�--'-
SIZE OF LOT NO. F BLDGS.
NOW ON LOT CHARGES
.USE OF
BUILDINGS CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
r---•^. - .. ---- -
- HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ j 3.50 I RECEIPT NO. I DATE +BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION.RECORDED'
WORK TO HOUSE SEWER " 1,00 NO, I DATE I BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION'DATA
SEPTIC TANK,SEEPAGE PIT OR r.
PITS AMD/OR DRAINFIELD 2.00 STATION 7 -Y�� Q DEPTH
CESSPOOL—DL MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY 2.00 I 4X6 S 6 4 UPPER ----- S'L'OWER
TYPE OF CONNECTIO LENGTH FROM
�_ P.
OWNERS PERMIT $ I 1 00 Y. CURB L.
M.L.TO P.L.
AUTHORIZATION .I TOTAL FEE
} I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
f CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATUREDATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS----,j- .--.DAY OF:�- ,_------ --.--.195-3NEW HOUSE SEWER
' CONNECT ADDITIONALOWNER OR AJ
OWNERS .AGENT2_- - -PLY3 - � �!�.: BUILDING OR WORK
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ADDRESS___4"-.e4�1�--.-��- cT-�YlT��Ia � --------.-- SEPTIC TANK,SEEP-PITS)
.......... .......:.C�.-�-� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE 1S,CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS' ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I. 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 ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S) CESSPOOLS E]SIGNATURE
OF PERMITTEE--:.
76A642D 663 1/53