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HomeMy Public PortalAbout6403 LOMA AVE_Sewer__ ` D 6&E.663 12.54 APPLICATION,, FOR PERMIT 1 ;.`6 8 E•6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of LOS Angeles BUILDING Jlj WM.J. FOX, COUNTY ENGINEER ADDRESS V CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST f CROSS ST4 ivo LEGAL 1 DESCRIPTION LOT NO. OWNER LOCK TRACT MAIL p DRESS 0. OF B1DGS. _ SIZE OF LOT /jjNOW ON LOT CITY TEL. NO USE OF BUILDINGS DISTRICT N0. GROUP MAP s ,r BK PG CONTRACTOR 1{ - ! f aS ADDRESS )) /� CONNECTION DATA CITY TEL. NO. 69� K JD STATION �' �91� DEPTH ❑ STATE MANACLE REFERENCE lILILOWER REGISTRATION NO. ❑ COUNTY_- / TYPE OF CONNECTIO�N� LENGTH FROM G No. DESCRIPTION OF WORK FEE Y. CURB (P.L M.L.TO HOUSE SEWER CONNECTING TO /I PUBLIC SEWER Ccs $ 3.50 1 (1 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 / CONNECT ADDITIONAL BLDG. OR CO. IMP. NO, D/ JOB, NO. WORK TO 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 CHARD S CONNECTION CHARGE FEE OWNERS PERMIT $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE �+ TRACTORHAVE TTOSCONNEECTO THECTED ABOVEWITH THE DESCR BE H EXISTINGAMED CON-DWELLIING APPROVALS DATE INSPECTORSSIGNATURE TO HE PUBLIC SEWER _ SIG ED THIS�_DAY OF 19 NEW HOUSE SEWER OWNR OR CONNECT ADDITIONAL OW RS AGENT /1 BUILDING OR WORK AD ESS 4 SEPTIC TANK, SEEP, PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL[IAND 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 DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCABANDONDISCONNECT PLUG SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIL PROPERTY. BACKFILL SC' -^'ARafs=[-} ® ,r S6,EP,P.-I-T.(�)=❑=CESSPOOLS© SIGNATURE C7QiL>s�l - OF PERMITTEE R�+� WILLIAM J. FOX,COUNTY ENGINEER VALIDATION BY tui v% c1 �Y�. C_• J 4 � ,� C7 DEPUTY DEPUTY �' ,BY BY ® DEPUTY DEPUTY