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Home My Public Portal About6221 LOMA AVE_Sewer__ CE8083-62 - APPLICATION FOR PERMIT , 76A642D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 42 JOHN A. LAMBIE, Count En ADDRESS Q v 9^ WILLIAM A. JENSEN, Sup't of Building t LOCALITY Z AA P 1 NEAREST FOR APPLICANT TO FILL I CRDSS BT LEGAL W.DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO OF BLDGS rr SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP CES ED BY BUILDINGS /BK PG [CA ONTRACT 4 DDRESS CONNECTION =TACITY L N STATION DEPTH 0444 1 STATE MANHOLE REFERENCE REGISTRATIO NO i 0 COUNTY NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER @ $5 00 O SEPTIC TANK,SEEPAGE PIT OR P C NO f, CO IMP NO .108 NO PITS AND/OR DRAINFIELD @ $1000 V HOUSE SEWER CONNECTING TO TRUNK PERMI O ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT w IVEN EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN,CESSPOOL DRYWELL MANHOLE @ $500 li ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO _ INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S 2 00 CHARGES AUTHORIZATION TOTAL FEE AUTHORIZATION 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 SIGNATURE SIGNED THIS DAY-OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 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 CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM 7HE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMI7TE SEEP PIT'(S) ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER (:C) M O CASH UICO 6 2 2 4 I OCT 3 0 1 0 D 5.0 0 -62 7CEIIOII 6A642APPLICATION! FOR PERMIT 6A642D COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS ' r WILLIAM A. JENSEN, Sup't of Building LOCALITY TE 7 NEAREST FOR APPLICANT TO FILL IN CRDSB ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACTS q.6 ADDRESS& A ( NO OF BL -5 SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO G OUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR '�z ADDRESS �•��/// CO ECTION DATA CITY TEL NO STATION DEPTH w • STATE MANHOLE REFERENCE REGISTRATION NO COUNTY NO DESCRIPTION OF WORK FEE TYPE OF CONNECTI N GTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ $10 00 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMI O / ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR -,• AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 / �� OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN,CESSPOOLDRYWELL MANHOLE @ $5 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NQ INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s 2 00 AUTHORIZATION TOTAL FEE ' CONNECTION CHARGE FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- T RACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE/ INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ c' , OWNER OR NEW HOUSE SEWER t �' OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE "tf Yk PIT(S) ElCESSPOOLS El LIDATION ROBERT A. WOOD UA M o CASH SUPERVISING MECHANICAL ENGINEER LAJ�o6 4 6 2'%"10- NOV 5 1 0 D 5.0a— r 24650 INSERTS CE808 8.80 PPLICA 0 �ON FOR PERMIT'- COUNTY 1 ER9 IT'COUNTY OF LOS ANGELES, SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS (� JOHN A. LAME, County Engineer ZE WILLIAM A. JENSEN. Sup't of Buildin4 LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGALDESCRIPTION LOT NO. '7 OWNER-BLOCK � TRACT MAIL ,ADDRESS O NO BLDGS.SIZE OF LOT 'NOW ON LOT CIY L� USE OF' �,(,LI DISTRICT N0. GROUP MAP �RR"ESSED BY BUILDINGS .—� BK IPG I CONTRACTOR WA 1 Q �C ( � � �f ADDRESS E CONNECTI N DATA - CITY PTEL.NO. _ STATION Z DEPTH - STATE MANHOLE REFERENCE _ REGISTRATION NO. B COUNTY LOWER NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ 00 TYPE OF CO NECTION LENGTH FROM PITS AND/OR SEPTIC DRAENFGELDT OR @ 3 00 Y. C ftB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT, DRAINFIELD vL EXTN CESSPOOL DRYWELL @ 2 00 HOUSE SEWER CONNECTING TO P.C.NO. �- PRIVATE DISPOSAL SYSTEM @ 00 CO IMP. NO. JOB NO. N CONNECT ADDITIONAL BLDG,OR TRUNK PERMIT NO. ROAD PERMIT NO. O WORK TO HOUSE SE @ 00 V ABANDO HOUSE iL STATE ENCROACHMENT ' SEWER OR @ $1.00 !J •PERMIT NO 0 O INDUSTRIAL WASTE APPROVAL W CHARGES al V OWNER'S PERM 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 SE E SIGNED THIS DAY F MAY 19 NEW HOUSE SEWER „ OWNER OR CONNECT ADDITIONAL - OWNERS AGENT kl3p NG OR WORK ADDRESS TANK,SEEP PIT(S) t NFIELD I HEREBY ACKNOWLEDGE THAT I HAV READ-THIS APPLICATION AND STATE THAT THE ABOVE IS CORK T AND AGREE TO COMPLY DRYWELL ❑ WITH ALL COUNTY ORDINANCES AN STATE LAWS REGULATING ,REPAIR,SEWER OR PLUMBING AND SEWERS E DISPOSAL SYSTEM J J LICENSEHERD ASCREQUIREDERTIFY HBY LOS ANGELES AT I AM PROPERLY COUNTY STAT OF D ANDOR NECT PLUG AND 17 /f 1CALIFORNIA OR THA}Tl AM THE LEG L OW ER OF THE ABOVEON HOUSE SEWER ?l T,DESCRIBED RESIDENT L PROPERTY. iiILL SEPTIC TANKS ❑ VSIGNATURE PITS _❑ CESSPOOLSMITTE OF VALMATIO ROBERT A. WOOD CIL H.o. , case SUPERVISING MECHANIC—AL-ENGINEER LI 4C_.3 o W i�r�y 2 4 L1 5.0 0 to