HomeMy Public PortalAbout6462 LOMA AVE_Sewer__ 71808-6•SS
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CAPPLICATION ,FO.8 - -E ■AVE-I Y. _ -
COUNTY OF LOS ANGELES StWER—SEWAGE DISP®SAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING.
r
ADDRESS•
JOHN-A. LAMBIE, County Engineer /
CASSATT D. GRIFFIN. Sup't of Building. LOCALITY'
NEAREST 1, u
FOR APPLICANT TO FILL IN CROSS'ST. 1
LEGAL
DESCRIPTION LOT NO. �z C� _ OWNER
BLOCK TRACT .�
ADDRESS-
NO.
DDRESS• �f`1•.2-��Q
- f•� NO.0 BLDGS.
SIZE OF LOT � Cl NOW ON-LOT - • .7�.. CITY _? TEL.NO.
USE OF
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.
BUILDINGS �/ /_ mit 'r DISTRICT'NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR r f t
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ADDRESS �� G. .... -CON CT ON DATA
CITY- yTEL. N0. STATION DEPTH
REGISTRATION N0. / �/� �- STATE 5' COUNTY MANHOLE REFERENCE
No. DESCRIPTION 0 W RK LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT ORy, CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3:00
OVERFLOW SEEPAGE PIT,DRAINFIELD -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @.$2.00 '
HOUSE SEWER CONNECTING TOP.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.-IMP,NO.' �r�/. . JOB N0,
CONNECT ADDITIONAL BLDG.ORTRUNK'PERMIT NO..%: ROAD PERMIT NO.
WORK TO HOUSE SEWER - @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 ,PERMIT'NO. _
INDUSTRIAL
WASTE APPROVAL -
CHARGES
OWNERS PERMIT S Z1 00 CONNECTION CHARGE FEE
AUTHORIZATION .TOTAL FEE.' REIMBURSEMENT'FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN-NAMED CON. APPROVALS'. DATE INSPECTOR'S SIGNATURE'
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING -DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF - .19 NEW HOUSE SEWER
OWNER.OR' CONNECT ADDITIONAL
.,
OWNERS AGENT j / BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DR INFIELD - -
I HEREBY ACKNOWLEDGE THAT- I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE -IS_.CORRECT AND AGREE TO COMPLY CESSPOOL❑ .DRYWELL❑ -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL.SYSTEM
I. HEREBY CERTIFY THAT I AM PROPERLYK7R�
RE? ANDIOR' DISCONNECT PLUG AND
LICENSED AS REQUIRED 'LOS ANGEL'E CD--STAT SOF ABANDON HOUSE SEWER
CALIFORNIA OR THAT IAM THE LEGA 0 HE: OYE
DESCRIBED RESIDENT PROPERTY. - BACKFILL SEPTIC TANKS[I
SIGNATURE f SEEP.PITS) ❑ CESSPOOLS'
OF PERMJTTI;-� iG- -Z- C<{
®F V LIDAr 'ROBERT A.•WOOD�
M..O, cAs - .SUPERVISING MECHANICAL ENGINEER
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