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Home My Public Portal About5043 SULTANA AVE_Sewer__ s.C'SOS 11 BB APPLICATION FOR PERMIT 1 DIVISION OF BULDING AND SAFETY SEWER—SEWAGE DISPOSAL DoPDz1101601a CGnaty Enghn Gout)( o! L,. Angela. BU ILDINB 64y 17�r JOHN A LAMBIE COUNTY ENGINEER ADDRESS ® CASSATTD GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FlU IN Noss�9T LEGAL A OWNER DESCRIPTION LOT MAIL BLOCK TRA ADDRES NO OF OLDGEF SIZE OF LOT NOW ON LOT CITY TEL NO ae USE OF DISTRIC O GROUP YAP BUILDINGS f J L BK PG CONTRACTOR "- CONNECTION DATA ADDRESS _ STATION DEPTH CITY TEL NO MANHOLE EFERENCE - UPPER ❑ STATE LOWER REGISTRATION NO ❑ COUNTY No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF NNECTION LE FROM PUBLIC SEWER @ S 3 SOI Y C B P L TO P L SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® 3 00 OVERFLOW SEEPAGE PIT DRAINFIELD P C NO EXTN ,CESSPOOL DRYWELL,YANHOLE S 2 00CO IVP NO JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® S 100 TRUNK PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROAC ENT WORK TO HOUSE SEWER ® S 1 00PERMIT NO ALTER REPAIR OR ABANDON HOUSE_ INDUSTRIA SEWER OR DISPOSAL SYSTEM ® S 100WASTE AP OVAL CHNGGES CO ECTION CHARGE FEE OWNER'S PEEtAT S 1 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEAPPROVALS DATE INSPECTOR 931G NATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DW TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS DAY OF 1CONNECT ADDITIONAL OWNER OB - - ." - _ BUILDING OR WORK ,. OWNERS AGENT SEPTIC TANK,SEEP,PITS) ADURFaa AND/OR DRAINF D I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICESSPOq DRYWELL❑AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO WITH ALL COUNTY0ROINANCES,ANO STATE LAWS REGUALTER REPAIR SEWEROR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED O ISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER of THE DESCRIBED RESIDE L P ERTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PITS) Cl CESSPOOLS❑ OF PERMITTEE - JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PL.9G INSPECTOR �0 1 4 2ZR SEP12 4 3.00 ' +0 `1OAPPLICATION FOR PERMIT TeAe411 so COUNTY OF LOS ANGELES DEPARTbg= OF COUNTY ENGINEER .SEWER-SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION eu1LDING Q Wm A LAb3lE County L w ApDRE8B WOJ.IAM A. IENSFZI, Soy If of Biddhwg LOCALITY NEAREST FOR APPLICANT TO FILL IN ` BY _ _ D ESCRIPTION LOT N OWNER MAIL OCK TRACT ADDRESS NO OF BLOO9 ZE OF LOT NOW ON LOT CITY TEL NO E OF pl[Tfl ICT NO OROUR MAP PROCESSED BY ILDIry OB BK Pa CONTRACTOR MFRE ADDRESSCONNECTION DATSTATION DEPTH CITY MANHOLE REFERENCE UPPER REGISTRATION NOLOWER NO DESCRIPTION OTYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNEY CURB P L M L TO P L PUBLIC SEWER PC NO SEPTIC TANK SEEPAGCO IMP HO JOB NO PITS AND/OR GRAINFIELD C [1000 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO (((� PRIVATE DISPOSAL SYSTEM 0 $300 CONNECT ADDITIONAL SLOG OR O AFFIDAVIT It[[ [[ [P[YT RECORD INQTR NO DATE WORK TO HOUSE SEWER O $I Go APW OVERFLOW SEEPAGE PIT GRAINFIELD E[TN CESSPOOL DRYWELL MANHOLE [BOD ALTER REPAIR OR ABANDON HOUSE HWY QRST ING 66WER OR DISPOSAL SYSTEM ® [100 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNER'S PERNIIT $INAMED GH AUTHORIZATION TOTAL FEECONNECTION CHARGE P[ I HAVE AT THIS DATE A CONTRACT WITH THE HERRQIMBUR9QM[NTRACTORTO COHN6CT THE ABOVE DESCRIBED EXIACCROVALSTO THE PUBLIC BEW[R DATB INSPECTORBBIONATURQ SIGNED THIS DAY OF OWNER OR NEW HOUR[SEWER - OWNKRIS AGENT CONNECTADDITIONAL BUILDING OR WORK ADDRESS [ND/OR ANN SCEP PIT(S) I HERESY E THAT THE ABO THAT 1 HAVE READ THIS APPLICATION AND/OR MAINPI6LD AND GALL THAT THQ DIVA IE CORRECT AND AOR[! E COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND BEW1116 CESSPOOL ❑ OflYW[LL ❑ 1 HERBS CERTIFY "AT I AM "OPENLY REGISTERED AND/ORLDI REPAIR SEWER OR LICEMBED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OFGE DISPOBAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OW R OP NO INTEND TONNECT PLUG AND RESIDE IN THE A GoV �E9 RI BEO �SIDQ IA OPE ON HOUSE SEWER SIGNATURE „w1 OF PEflMITT[[ ILL 5) 0 TANKS ❑ Fly(5) ❑ C[16POOLB ATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK Al O CABH 1_;Q8 3 5 5G FEB 8 1 0 D 5,00~ v TIM�AO APPLICATION FOR PERMIT k,,.�,d ,,�`°i� �v S COUNTY OF LOS ANGELES SEWER-SEWAGE DI POSAL DEPARTbI NNT OF COIINTY ENGDOM BUMI)ING AND SAPE[Y DMSION ADDRESS O JOHN A. LAIa, CemtT avins . CAWATL D GEWM,MMD'!RI DWEI LOCALTR NEAREST FOH APPLICANT TO F I M I N OS!ST LEGAL r DESCRIPTION LOT NO O OWNER BLOCK TCT MAITRACTL �+ ADDRESS NO OF BLDGS SIZE OF LOT O NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT GROUP WAP OCES�BY CONTRACTOR BK f0 ADDS Z /CONNECTION DATA C NO 3 STATION TJEP7x REGISTRATION NO COUNTY MANHOLE REFERENCE UPPER No D SCRIP OF WOR FEE L0� HOUSE SEWER CONNECTING TO PUBLIC SEWER 3 00, gEPTIC TI�NR,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AXD/OR DRAT MF IELD 300 T CURB P L Y L TOP L OVERFLOW SEEPAGE PIT DRAINFFI6L E1ITN CESSPOOL DRTWELL MAN 00 B E 00 HOUSE SEVER CONNECTING TO P C p0^ PRIVATE DISPOSAL STSI'E 100 CO IMP CONNECT ADDITIONAL B OR TRUMK PERMIT NO ROAD PERMIT M WORK TO HOUSE!EWER ALTER REPAIR OR ABA;NN HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL 3T Y 1 00 PERMIT NO INDUSTRIAL WASTE APPRO AL CHARGES OWNER'S PERMT Z 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL PEE 10F EIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED APPROVALS. DATE INSPECTOR BSIONATURQ TRACTOR TO CONNECT THE ABOVE DESCRIBED ¢ISTING DW TO THE PUBLIC SEWER SIGNED THIS MAY OF INEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK " 9EPTJC TANK SEEP PIT(!) ADDec� AND OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI AND STATE THAT THE ABOVE I! CORRECT AMD AGREE TO CCESSPOOL DRTWELL LL WITH ALL COUNTY ORDINANCE! AND STATE LAWS REGUALTER REPAIR SEWER OR PLUMBING AND SEWERS EWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AISCONNECT PLUG AND LICENSED AS REQUIRED BT LOS ANGELES COUNTY AND STABANDON ROUSE SEWECALIFORNIA OR THAT I AY THE LEGAL OW DESCRIBED R681DENTIAL OP EEP PIT(ACKFILL��C CESSPOOLS SIGNATURE OF PERYI ®r VALIDATION ROBERTA WOOD CK t o (Q?J C-. ) GUPSRVIOIHG 191IC"ANICAL QNGINBiR M5 9 2 09; APR 29 1' 0-A 3.00 Tewesao .�,, sae 46SUan APPLICATION MR PERMIT , 1 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL DopDztr3ent of County Engineer County of LOS Angela/ BUILDG Q JOHN A LAMBIE.COUNTY ENGINEER ADDRESINS ® CASSATT D GRIFFIN SUP T OF BUILDING LOGLITY . FOS CROSS n LEGAL T ' OWNER DESCRIPTION LOT ��I�ISJ MAIL BLOCK TRACT O AGGRESS / 7 ' NO OF BLT - CITY a TEL NO 7L 6 6114 9I OF LOT NOW ON LOT USE OF 1' DISTRICT NO GROUP YAP USE OF BK PG CONTRACTOR L� CO ON DATA ADDRES / STATION -. / DEPTH CI NO lJ MANHOLE REFERENCE _ UPPER REGISTRATION NO LI-}�COUN LOWER O" of ❑ coonTY _ No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF COMXECTIO LENGTH FROM PUBLIC SEWER @ $S 90 QD Y CURB P L Y L TOP L SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® $3 00 OVERFLOW SEEPAGE PIT GRAINFIELD P C NO EXTN CESSPOOL DRYWELL MANHOLE ® S t 00 CO IMP NO LePm JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM a S 100 TRUNK PERMIT NO ROAD PERMIT NO CON N ECT ADDITIONAL BLDG OR STATE ENCROACHMENT - WORK TO HOUSE SEWER ® S 100 PERMIT NO ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL ' SEWER OR DISPOSAL SYSTEM ® 1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S FEEMlT : a OD AUTHORIZATION TOTAL FEE O REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER S NEW HOUSE SEWER _ Qw �✓ SIGNED THI DAY OF �9 CONNECT ADDITIONAL fY OWNER OR l BUILDING OR WORK OWNERS AGE SEPTICTANK,SEEP PIT(S) - ADDRE9 AMD/OR DRAINFIELD IN ACKNOWLEDGE THAT I HAVE READ THIS'APPLICATIO 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 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT CT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEHOUSE DESCRIBED RESIDE L OP 0.TY BACKFILL BaaH�MNlsB SIGNATURE �aeeeeCM�9 CESSPOOLS a. OF PERMITTEE JOHN A LAMBIE COUNTY ENGINEER ATION ROBERT A WOOD CHIEF PLBG jNSPE=R ca ■ oCASH - _ ;D 5 7 1 8 v APR 2 7 1 0 A 5.