HomeMy Public PortalAbout5038 SULTANA AVE_Sewer__ DEPAULTMENT OF OOUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUMDING AND SAFETY PERMIT APPLICATION
OOUNTY OF LOB AN0ELE8 r
WILLIAM J. FDX. CDUNTY ENGINEER ADDRESS b7 �y q
ADDRESS V Y
FOR APPLICANT TO Fl LOCALITY
ADDRES6 D NEAREST
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LOCALITY DISTRICT NO SERIAL NO PERMIT NO.
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00 ItlP NO
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JOS NO
CITY TEL NO TRUNK PERMIT NO
STATE
REOISTRATI0 0 Q COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO STATE
TENO NCROACHMENT
PERMITBLOCK TRACT INDUSTRIAL
WASTE APPROVAL
812E OF LOT NO OF BLDGB
NOW ON LOT CHARGES
USE
BUILDINGS CONNECTION CHARGE FEE
No DESCRIPTION OF WORK FEE -.
HOUSE SEWER CONNECTINS TO REIMBURSEMENT FEE
PLOLICSEWER OD ! 830 RECEIPT NO DATE BY
HOUSE SEWER CONNECTING 0 oJ; dL`a/L, / �_, _ -
PR.VATE DISPOSAL SYSTEM 100jaa
Zd-NNE-CY-ADDITIONAL BLD0 OR ` )k,X`,Tr ITgCEPTIOM RECORBED'}„ .`
WORK TO HOUSE SEWER 100
AL EROR REPAIR EX18T1M NO DATEBY
SEWER OR DISPOSAL SYSTEM 1.00 �/:1,.✓ffri '� "'
DISCONNECT AND ABANDON SEWER A _
AMD/OR DISPOSAL SYSTEM 100 CONNECTION DATA-
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PS AMD/OR GRAINFIELD 2.00 STATION DEPTHIOESSFOY
OL—DRYWELL .
SPECIAL CONDITIONS ONLY 200 .a- MANHOLE REFERENCE
r UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT = 1 'pD Y CURB PL ML TOP L
AUTHORIZATION TOTAL FEE BO -
I HAVE THIS DATE CONTRACTED WITH-THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INS EcToFrqoetGNATURE DAYE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS- DAY OF _ 19_ NEW HOUSE SEWER �/A.ZA, 3
OWNER OR - CONNECT ADDITIONAL-
OWNERS AGENT -_ __ __ _ _ - __ _ _ _ BUILDING OR WORK
ADDRESS _
AND/0 TAM E OPIT(8)
-1-HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLE CESSPOOL 0 DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEW ER Ofl
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED '
AND/OR DISCONNECT PLUG AND
LICENSED A8 REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE D SCRIBED REBID AL PROPERTY _ AC TANKS1"'�
SIGNATURE SEEP PIT(S)[:] CESSPOOL90
-OF PERMITTEE -
TOAO/2D 000 1/62
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APPLICATION FOR PERMIT
a.oB B RA COUNTY OF LOS ANGE-0
DIWART�NT OF COUNTY ENGn� SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
1fR1! `
ICY A. ♦. Com BWIGoa ADDRESS
CASSATT A GRWFnL OWL of BmlmeG LOCALITY
NEAREST
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FOR APPLICANT TO .117 OSS Sr IN.� /
DESCRIPTION PON LOT NO 1 PT 7 U.S E-A OWNER ) / [J Xl (J/i/� 4
BLOCK TRACT JR5 $ 6— /a -I DRESS T�
r NO OF BLDGS
SIZE OF LOT J NOW ON LOT CITY 0
USE OF
BUILDINGS DISTRICT NO GROUP RK YAP PG PROCESSED By
CONTRACTOR O.
T q3
ADDRESS 1317 COLEGROVE AVE C NNECYION DATA
CITY MONTESELLOT91. NO PA. 1-5048 STATION L DEPTH Ff-
REGISTRATION NO
180767STATE ouxTETY MANHOLE REFERENCE UPPER
NO DESCRI O FEE
HOUSE SEWER CONNECTING TO
9PUBLIC SEMEN g S 00 TYPE OF CONNECTION LENGTH FROM .
PITS A{N,O/OSREDMI NFIETLDIT OR p Lp S 00
T CURB L Y L TO P L
EZTHF CESSPOOLAON4ELL MANHOLE 0 42 00
HOUSE SEWER CONNECTING TO P C RO
•PRIVATE DISPOSAL SYSTEM 1 00 CD IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR �' TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER 1 DO
ALTEREPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER R DISPOSAL SYSTEM 1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S FEWiT S 2 00 CONNECTION CHARGE FEE
AUTHOHPLATiON From FFE I a REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS - D INSPE H SIGNATURE
TRACTOR TO CONNECT THE ABOVE D BED EXISTING DWELUNG
TO THE PUBLIC SEWER
SIGNED THI AY I NEW HOUSE SEWER
OWNER OR COX NECT ADDITIORAL
OWNERS AGENT BUILDING OR WORK
BEPTICTANK SEEP PIT(S)
ADD AND/OR DRAINFIELD
I HEREDY AC WUMGE THAT 1 HAVE READ THIS APPUCATIOR
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPU CESSPOOL Q DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM '
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERAID AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAI 1 THE AZWkL OWNER OF VE
DESCRIBED REST BACKFILLS _/�
SIGNATURE CE�POOL9
F PERYI
®r /�AIMATION ROBERTA WOOD -
cA ■ a CASH SUPERVISING MECHANICAL ENGINEER
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