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Home My Public Portal About5017 SULTANA AVE_Sewer__ =804 a w APPLICATION FOR PERMIT 1 aro°° COUNTY OF LOS "CHE.PS SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGnG= BUMMING AND SAFETY DIVISION BUILDING ADDRESS JOHN E. r.>�PNIR Cem1T�a CASSATT D GRlnM. Sq I of Building LOCALITY NEAREST OH CANT O IN CROSS ST LEGAL DESCRIPTIO LOT NO I OWNER I BLOCK MAIL DDRES! NO OF B 3 DBE F LOT NOW ON CI TEL NO USF- OF BUILDING! DISTB,IaR�NO GROUP YAP PROCESSED BY CONTRACTOR ER CONST.CO. , d BE IgPG ADDRESS 1317 COLEGROVE AVE. CONNECTION N D DATA CITY MONTEBELLOTEL No PA 1-5048 STATION �— DEPTH REGISTRATION N0 180767 STATE COUX'IT MANHOLE REFERENCE UPPER NO p DESCRIPTION R FEE - LOWER PUBLICER�CONRECTING TO 300 ;EPTIC TARN figPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR OMI NFIELD 300 T CURB PL Y L TOP L OVERFLOW SEEPAGE PIT DRAIN FIELp EXTN CESSPOOL DRYwhL MANHOLE $200 HOUSE SERER CONNECTING TO P C NO PRIVATE DISPOSAL SYSTEM 100 ',11 CO IMP RO JOB NO MORN C HO DIJI98MERB R 100 B V THUNK PEBYIT NO ROAD PERMIT NO ALTER,REPAIqq OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DI SPoSAL SYSTEM 1 DO PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNIMS �T 2 CONNECTION CHARGE FEE AUTHOFMTION TOTAL PEE dEIMBUR3EYERT PEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COR APPHOV DATE INSPECTOR S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SIGNED TH AY P )G �O NEW HOUSE SEWER OWNER OR '" T CORNER ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TARN SEEP PIT(S) AD AND OR DRAINFIHLD 1 HEREBY ACKNOWLEDGE THAT 1 HAREAD THIS APPLICATION - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ORTWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR PLUMBING AND SEWER! SEWAGE DISPOSAL SYSTEM I HEREBY CERTIR M T REGI AND/OR DISCONNECT PLUG AND LICENSED AS REOUI T L AM E CWRTT AND STATE OF ABANDON ROUSE!EVER CALIFORNIA OR T 1 11 OWNER P THE ABOVE DESCRIBED REBID IAL P BACKFILL!H C TANKS OLE r SIGHATURH SEET PITS C 3P00 F PER■ I i mr VAIMA ON ROBERTA WOOD a ■ G Cue SUPERVISING MECHANICAL ENGINEER ;AC06'256—� NAY • 614 A 300 n 11175 s&c Ga9APPLICATION FOR PERMIT 1 IMSION OF BUMDING AND SAFETY SEWER—SEWAGE DISPOSAL DepmtaAm! of ConntF En9leeer County of LoB Angeles BUILDING JOHN A L.AMBIE COUNTY ENGINEER ADDRESS ® CASSATTD GRIFFIN SUPTOFBUILDING .. LOCALITY NEARST FOR APPLI TO,FILL IN CROSS SST LEGAL llul DESCRIPTION LOT Nlovcll� OWNER /BLOCK TRACT MAIL ADDRESS NO OF BLDG$ CITY TEL NO - 91ZE OF LOT NOW ON LOT USE OF BUILDINGS l DISTRICT NO GGR SK MAP PS �! CONTRACTOR CALIF.SEWERCO T. S (/ 1317 COLEGROVE AVE, ONNECTION DATA ADDRESS 1 STATI CITY MONTEBELLOEL No PA 1-5048 MANON DEPTH ON REFEREENN CE � UPPER 180767<I/y(STATE) ❑ STATE REGISTRATION NO ❑ COUNTY NO DESCRIPTIONOFWORK FEE TYPE OF CONNECTIOM•1f� LEN HOUSE M ROUSE SEWER CONNECTING TO Y CURB L 1 Y L TO P L �Y PUBLIC SEWER @ S 3 SO SEPTIC TANK SEEPAGE PIT OR PIT$AND/OR DRAINFIELD ® $3 00 OVERFLOW SEEPAGE PIT DRAINFIELDCO ItlP NO JOB NO EXTN CESSPOOL DRYWELL,MANHOLE F� S, 00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER ® S 100 PERMIT NO ALTER REPAIR OR ABANDON SEWER INDUSTRIAL SEWER OR DISPOSAL SYSTEM ® 1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 00 AUTHORIZATION TOTAL FEE a REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVAIS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEW NEW HOUSE SEWER SIGNED THIS A OF CONNECT ADDITIONAL ' OWNER OR I BUILDING OR WORK OWNERS AGENT SEPTIC TANK SEEP,PIT(S) ADDRESS— AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I ROPE LY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY A GELE C TY ANO TATE OF - CALIFORNIA OR THAT I TH LEG N OF T E ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL OP ACKFILL 9YFli&eelMle,t.]r J SIGNATURE �PP� CESSPOOLS ae OF PERMITTEE JOHN A L.AMBIE COUNTY IN VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR CK K 0 WN 1AMAOP-5983 � !IN 11 0 A 5.0O f; e s It a6211 ee APPLICATION FOR PERMIT 1 DIVISION OF BUIEMING AND SA= SEWER—SEWAGE DISPOSAL Department of County Engineer County of Loe Angeles [::A DING�D/ JOHN A LAMBIE COUNTY ENGINEER m DDRESS CASSATT D GRIFFIN SUP T Or BUILDING LITY FOR APP ANT TO FM,IN CROSS SST LEGAL DESCRIPTION LOT NO i ER r BLOCK TRACT ESS .Z �� NO OF BLOCS TEL NO SIZE OF LOT NOW F LOT USE DI STRICT NO GROUP YAP BUILDINGS L 1 BK PG CONTRALTO aJ ADDRESS �� CONNECTION DATA ' QION DEPTH CI TEL HO Si UPPER HOLE RE 'RENCE RlGIBTRATION NO ®"STATE LOWER ❑ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CON P CTION LENGT ROM PUBLIC SEWER (N S D SO CURB P L M L TO P L SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD $3 00 OVERFLOW SEEPAGE PIT DRAtMPtM P NO ® i 2 00 Q CO IMP NO OB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM S 100 TRUNK PERMIT NO OAD PERMIT NO - CONNECTADDITIONALBLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER $1 00 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM ® S 1 00 WASTE APPROVAL CHARGES CONNECTI CHARGE FEE OWNERS PEDW S 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL PEe oo " I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS _ DATE INSPECTOR SSIGNATURF� TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT BEPTICTANK BEEP,PIT(S) ADDRESS AND/OR GRAINFIELD 1 4qM 1 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE! 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 ANO STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ _ SIGNATURE SEEP PITS) ❑ CESSPOOLS❑ OP PERMITTEE , JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WC OOD, CHIFF PLBG INSPETOR `� (&a o .tui 11 4 3.00 ID