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Home My Public Portal About6236 LOMA AVE_Sewer__ 0-63 76A642D APPLICATION FO PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADORES WILLIAM A. JENSEN, Sup't of Building L OCAL,TY NEAREST FOR APPLICANT TO FILL IN CROSS BT LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS �S NO OF BLDG SIZE OF LOT NOW ON LOT CIT TEL NO USE OF DISTRIIIj I GROUP MAP PG PROCESSED BY BUILDINGS ./ BK CONTRALTO f ADDRES ' CON/NECTION DATA TEL N MJ /� 5T/ION / Ly DEPTH 14-1 UP REGISTRATION NO ?® f� CO NTY MANHOLE REFERENCE I� ` L-OPE R NO DESCRIPTI N OF WORK FEE TYPE OF CONN CT O GGG+//�LENGT��/Hll FROM USE SEWER CONNECTING TO Y C L, M L TO P L <570 > PUBLIC SEWER @ $5 00O_ SEPTIC TANK,SEEPAGE PIT OR '+(.+ P C NO O PITS AND/OR DRAINFIELD @ E10 00 CO IMP NO JOB NO ///��/� / V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO �C C PRIVATE DISPOSAL SYSTEM @ $3 00 ^ CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE H WORK TO HOUSE SEWER @ $3 00 OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN,CESSPOOL DRYWELL MANHOLE @ $5 00 d ALTER REPAIf30 M NDON HOUSE HWY ORST WIDENING h D SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE IHAVE 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 ADDRESS BUILDING OR WORK 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 WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL I HEREBY CERTIFY TH T I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT AM THE EGAL OWNER OF, D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB DESCR D R SIDEN/TIAIAL PERTY ABANDON HOUSE SEWER SIGNATURE �+ BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ SEEP,PIT(S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD CK M O cnsH SUPERVISING MECHANICAL ENGINEER - L o•=o'7'4;3 JUN 15 1 1 a 2 5#0 0,~ 4 0-63 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDINGss .y� JOHN A. LAMBIE, County Engineer rLOCAL.TY,,,;..,.. ., oDRE WILLIAM A. JENSEN, Sup't of Building NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT '5-v'oolADDRESS V (t—�NO OF BLDGS D SIZE OF LOT �� V NOW ON LOT CIT TEL NO USE OF BUILDINGS DISTRICT O GROUP MAP PR ESSED BY L BK PGcr,�� CONTRACTO AD Ess .••11J" CONNEEC/TIONvDATA TEL NO S /TION Y DEPTH r 000 rUPPER ry� TATE MANHOLE REFERENCE REGISTRATION NO !� COUNTY -L09R>`R' NO DESCRIPTION OF WORK FEE TYPE OF CONNECT LENGTH FROM HOUSE SEWER CONNECTING TO �� Y CU 6 P L M L TO P L �_ } PUBLIC SEWER SS 00 PC NO d SEPTIC TANK,SEEPAGE PIT OR 1013 NO Q PITS AND/OR DRAINFIELD @ S10 00 CO IMP NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO �//'�' V PRIVATE DISPOSAL SYSTEM @ $3 00 " 1, CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER ® $300 V OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN CESSPOOL,DRYW ELL MANHOLE @ SS 00 a ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h SEWER OR DISPOSAL SYSTEM @ 53 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S 2 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE D IHAVE AT THIS DATE AT CONTRACT WIT E HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT HE ABOVE DE RI ED EXISTING DWELL[ APPROVALS TO THE PUBLIC SE 'y�VJE / DATE INSPECTOR'S SIGNATUR�' SIGNED THIS DAY F j I OWNER OR NEW HOUSE SEWER 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO V DESCRI D RESIDENTIAL P PERTY ABANDON HOUSE SEWER SIGNATURE If BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD CK M o CASH SUPERVISING MECHANICAL ENGINEER _ - L&-,o 0 '3 e im 15 l o u 7.0 0-