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HomeMy Public PortalAbout6260 LOMA AVE_Sewer__ ' r ® pp��py p�m�( 7 `.S&EAB 312-54 APPLICATION- FOR■ PERMIT � 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles ADDRESSG (p U T WM. J. FOS;. gOUN7Y ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY. FOR APPLICANT TO FILL IN NEAREST CROSS ST. LEGAL 7 � DESCRIPTION LOT NO l OWNER BLOCK TRACT L� u MAIL / (� -Fix / NO OF BLDGS. ADDRESS _ SIZE OF LOT O x ` 3 NOW ON LOT CITY TEL NO USE OFq BUILDINGS 1 Z L DISTRICT N I G I MAP BK PG CONTRACTOR ADDRESS 6 CONNECTION DATA CITY , TEL. NO. (y Ij^V STATION DEPTH STATE MANHOLE REFERENCE REGISTRATION NO. 0 /1�� ❑ COUNTY UPPER LOWER 1 TYPE OF CONNECTION LENGTH FROM No. DESCRIPTION OF WORK FEE Y CURB P L. �y.M L TO P.L. HOUSE SEWER CONNECTING TO ��>�"� _PUBLIC SEWER "Q $ 3 50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR / �- CO 151P N0. JOB NO WORK C HOUSE SEWER 1 00 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 CHARGES CONNECTION CHARGE FEE OWNERS PERMIT g 1 00 AUTHORIZATION TOTAL FEE - REIMBURSEMENT FEE TRACTORHAVE T TOS CONNECT DATE CO ONECTONTRTHEA ABODVEWDESCR BED EXISTINGITH THE HEREIN A DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS DAY OF 19 OWNER OR CONNECT ADDITIONAL "a{l OWNERS AGENT BUILDING OR WORM. (J➢RT! 1111 . �� SEPTIC TANK, SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[-IDRYWELL❑ 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 CCRTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. \ BACKFILL SEPTIC TANKS[ISIGNATURE SEEP.PIT(S) ❑ CESSPOOLS❑ OF PERMITTEE WILLIAM J. FOX, COUNTY ENGINEER VALIDATION r BY ..,kC0 4 6 OB 9`; 'JUN 13 4 2.0 0 DEPUTY DEPUTY BY BY �"® DEPUTY DEPUTY DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING A� CASSATT D. GRIFFIN SUPT OF BUILDING ADDRESS ;Z AZ FOR APPLICANT TO FILL, IN LOCALITY BUILDING NEAREST ADDRESS CROSS ST .� Q�� DISTRICT NO A SERIAL NO. PERMIT N0 �� ��� LOCALITY (- �j NEAREST c b �` " �S CROSS ST. I RE�RCE}��I�VyED Y Ready for Inspection aDATE ISSUED OWNER �J pFIUT ,.!, ��� MAIL �/ w USE ZONE OCCUPANCY MAP ADDRESS /S /1L- -�j J BK PG CITY &"�TEL.N0. CONTRACTOR Al -/ u 1 CHARGES REIMBURSEMENT FEE- ADDRESS �,�o 7�1lJJ n��-�� REQUIRED �`�. NOT REQUIRED CITY TEL.I `/ Z 510,0 7 )OB NO. CONNECTION EEE STATE REGISTRATION NO ��� N CID NTY p r CO. IMP.NO LEGALRECEIP\O. I DATE I BY ry DESCRIPTION LOT NO. f� '7z A BLOCK TRACT '_-s'p® '�;z WAIVER FOR RECORDING SIZE OF LOT NO OF BLDGS. RECEIPT NO DATE BY NOW ON LOT USE OF .41 —BUILDINGS �s( �'_ ��C>� TRUNK PERMIT NO. NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO ROAD PERMIT NO. PUBLICSEWER Q $ 3.50 HOUSE SEWER CONNECTINGTO STATE ENCROACHMENT PRIVATE DISPOSAL SYSTEM 1.00 I PERMIT NO. CONNECT ADDITIONAL BLDG.OR INDUSTRIAL WORK TO HOUSES EWER 1.00 WASTE APPROVAL ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION TA DISCONNECT AND ABANDON SEWER \\ AND/OR DISPOSAL SYSTEM 1.00 I STATION DENTH SEPTIC TANK,SEEPAGE PIT OR lk PITS AND/OR DRAINFIELD 2.00 I MANHOLE REFERI!NCE \ CESSPOOL—DRYWELL UPPER 0 LOWER SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONFECTION LENGTH F OM Y ,,CURB P.L. M.L.TO P.L OWNERS PERMIT $ I I 00 AUTHORIZATION I TOTAL FEE 1 �.100 CO THAVE THIS DATE CONTRACRACTOR TO CONNECT THTE ABOVE D SCRIBEDWITH THEI EXIISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS___ . ._..DAY OF NEW HOUSE SEWER r --=-- 19�5-'d — OWNER OR CONNECT ADDITIONAL OWNERS AGENT!r/! ! ...GhrCiGf/lrYiS'i�P•1ase BUILDING OR WORK .........................- � . SEPTIC TANK,SEEP.PIT(S) ADDRESS r,.. !.__!:Y_ Q ✓�................... AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- USESEWER ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS t - SEEP.PIT S [] CESSPOOLS❑ E SIGNATURl�Q�r} n - , fry,+5.✓ i OF PERMITTEE----•::--;-------------•---=-'----: ------------------------------ i 6A642D 663 12/52"