HomeMy Public PortalAbout6214 LOMA AVE_Sewer__ E-663
9&E69 3.86 APPLICATION FOR PERMIT
8&E-8
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL.
Department of County Engineer
County of LOS Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY
OR APPLICANT TO FILL IN NEAREST ;
CROSS ST.
LEGAL /'
DESCRIPTION LOT N0, l'� OWNER
BLOCK TRACT AV, MAIL
ADDRESS
/� NO O�BLDGS. ,I�, •�
SIZE OF LOT �/ NOW ON LOT. oC. CITY EL NO �trp1
USE OF l•
BUILDINGS DISTRICT NO. GR UP MAP
—511 BK PG
CONTRACTOR of 0 ;?_5ADDRESS J 9 5 CONNEECCT`ION DATA
CITY A. TEL NO.4 d6 "X14COOV STATION DEPTH
❑ STATE MANHOLE E3RE EREN c �� ��/ _B1rB
REGISTRATION NO. COUNTY LOWER
NO DESCRIPTION OF WORK FEE
TH FROM
HOUSE SEWER CONNECTING TO � c
Y. TYPE 0 URB NECTIOP L MEL GTO P L. Q /
PUBLIC SEWER Q $ 3 50 ,.;/0
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR P C NO.
WORK TO HOUSE SEWER 1.00 0 -CO. IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK„ SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARG
,,OWNER'S PERMIT 5 1 OO CONNECTION CHARGE FEE,
AUTH(Oi RIZATION TOTAL FEE O REIMBURSEMENT FEE
TRACTORHAVE TTOS CON ECTO THEAABOVE DESCRIBED EX[STINGCTED WITH THE HEREIN NAMED
DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SE R
SIGNED THIS DAY NEW HOUSE SEWER
OWNER -eft—CONNECT ADDITIONAL CC IAk'
e _ BUILDING OR WORK
ADDRESS ✓F r { SEPTIC TANK,SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[:1 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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑
Old Slip D
SIGNATURE SEEP. PITS) ❑ CESSPOOLS
-OF PERMITTE - I -
WILLIAM J.FOX.COUNTY ENGINEER %AAMATION R-f A.WOOD. CHIEF PLBG. INSPECTOR
L 3 7 MAR 5 4I-K
in
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