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HomeMy Public PortalAbout6449 LOMA AVE_Sewer__ 6AV42-64 7 D APPLICATION FOR PERMIT 76A A42 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS �f WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CRo3s ST. LEGAL ly DESCRIPTION LOT NO. OWNER MAIL BLOCK BLOCK TRACT •�j-v ADDRESS NO, OF BLDGS. f 7/ ?,7o 512E OF LOT NOW ON LOT CITY TEL. •NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS �.• r/'V � BK CONTRALTO tSl ADDRESS p, CONNECTION DATA . CIT ' TEL. NO L�( 0 STATION '- DEPTH / -7TATE MANHOLE REFERENCE UPPER REGISTRATION NO. Q !/ ❑ COUNTY y _ NO. CESCRIPTI N OF WORK FEE TYPE OF CONNECTION LENGTH FR M HOUSE SEWER CONNECTING TO �DO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ 35.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. >_/ G� a PITS AND/OR DRLD JOB NO. 310.00 CO.IMP.NO. INFIELD O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U PRIVATE DISPOSAL SYSTEM @ 33.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAlv[[ [n8[M[NT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 O ERFLOW SEEPAGE PIT,DRAINFIELD OVU EXTN.,CESSPOOL,DRYW ELL.MA MANHOLE $5.00 HWY.OR ST.WIDENING 0- ALTER.REPAIR OR ABANDON HOUSE LLI SEWER OR DISPOSAL SYSTEM d 83.00 STATE ENCROACHMENT f/I PERMIT NO. Z INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE OD '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR 70 CONNECT THE ABO�IE DWELLINGTOTHE PUBLIC SEW APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY19_ OWNER OR NEW HOUSE SEWER . �� � '6; fid; OWNERS AGENT l W v CONNECT ADDITIONAL � BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PITS) 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 ❑ I HEREBY 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 L GAL OWNER OF. A INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO ESCRI RE TIALZPERTY' ABANDON HOUSE SEWER SIGNATURE �� BACKFILL OF PERMITTSEPTIC TANKS ❑ ©�p(� /�' ...yw3y(4 .. EE SEEP.PIT S) ❑ CESSPOOLp VALIDATION ROBERT'A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.0. CASH r,-0_63 76A646A642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CR OSS 5T. LEGAL DESCRIPTION LOT NO. ./� OWNER /�' / MAIL BLOCK TRACT / a % ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. .NO. USE OF BUILDINGS - DISTRICT NO. GROUP MAPPROCE ED BY - � BK PG � CONTRACTOO� ,.r AV ADDRESS 4 CONNECTION DATA CI Y- TEL. NO. �.6 3�� STATION DEPTH �J STATEMANHOLE REFERENCE UPPER REGISTRATION NO. �/ O [D COUNT Y LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. } PUBLIC SEWER - @ $5.00 P.C. NO. SEPTIC TANK,SEEPAGE PIT OR MP.NO. .108 NO. O PITS AND/OR DRAINFIELD @ 510.00 CO.. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE O WORK TO HOUSE SEWER @ $3.00 prJ V OVERFLOW SEEPAGE PIT.DRAINFIELD LIJ EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING N SEWER OR DISPOSAL SYSTEM @ 53.00 J1 STATE ENCROACHMENT Z �i><+✓?/fO - �j ./S .�i r� / PERMIT NO. / G INDUSTRIAL �✓ `9 �C-� -+ _ n WASTE APPROVAL Cf OWNERS PERMIT S AUTHORIZATION TOTAL FEE �� CONNECTION CHARGE�FEE CHARGES '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 ADDRESS BUILDING OR WORK .T 490 SEPTIC TANK.SEEP,PIT(S) G I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE .LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED B OS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM I CALFORNIA OR THAT I HE LEG L OWNER OF, AND TEND TO DISCONNECT PLUG AND RES DE IN, THE ABOV SCRIBE ESIDE TIAL PROP Y. C/'J %ABANDON HOUSE SEWER. SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP.PIT(5) ElCESSPOOL VALIDATIO ROBERTEA. WOOD P SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH