HomeMy Public PortalAbout5047 SULTANA AVE_Sewer__ ""e'R°
c ea!�1 ea APPLICATION FOR PERMIT 1
a•
D114WON OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Eagln�ar ,!
County of LOB Ing ADDRE540 ��}
WM J FOX, COUNTY ENo1NE[R
IdL-
CASBATT D GRIFFIN BUP T OF BUILDING LOCALITY,
FOR APPLICANT TO FD.L IN NEAREST
CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL
ADDRESS
NO OF BLDGI
SIZE OF LOT NOW ON LOTS CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP I MAP
CONTRACTOR SK PG
1-5-
ADDRESS74 %aL&d9z CONNECTION DATA
CITY EL NO STATION DEPTH ,
STATE MANHOLE REFERENCE
REGISTRATION NOP 7S-'? 7 ❑ COUNTY UPPER LOWER
TYPE OF ONNECTION LENGTH FROM
No DESCRIPTION OF WORK FEE r COKE P L M L TO P L
11OUSE SEWER CONNECTING TO
PUBLIC SEWER ® S-3-50
HOUSE SEWER CONNECTING TO ^^
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO IMP NO B RO
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER EM CROAC
'ANO/OR DISPOSAL SYSTEM I DO STATE STATENO
SEPTIC TANK SEEPAGE PIT OR PERMIT
PITS AND/OR DRAINFIELD 2 00 INDUSTRLArC
CESSPOOL-DRYWELL —� NAST PROVAL
SPECIAL CONDITIONS ONLY E 00 CHARGES
CONNECTION CHARGE FEE ,
OWNS@'$ PERMIT S 1 00
AUTHORIZATION I TOTAL FEE OO REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSP OR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THISDAY OF 19—
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK SEE IT'S)
AND/OR DRAINFIEL D
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 ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWER! PAIR.ALTER RESEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE PAIR,AL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNS OF THL ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY
BACKFILL ei C TALARS
SEEP PIT(8) CESSPM
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX.CGuNrY ENOINEIR VALIDATION
ACo 6 9 6 010, AUG 2 2 4 _ 400
In
Br BY -
DEPUTY DEPUTY
•BY By
�'/�
0 DEPUTY i /QJ ,"C�"_`^'�LLJ DEPUTY
Tax -
CSSOS' °' APPLICATION FOR PERMIT
TawBAEG COUNTY OF LOS ANGELES
DEPARTbUM OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING Sb45.�
WMA
LAM M C. CDquw ADD Res{
WILLIAM A JEI'ISet< SGB i d DWdiDa
LOCALITY p
FOR APPLICANT =FILL IN
CRAB{ 6T
LEGAL
�j
DESCRIPTION LOTN ,. /1 OWNER
FA MAIL
BLOCK TRACTADDRESS a �S 0 r �^
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICTNO ORO MAP PROCESSED BY
//^11 PO?
CONTRACTOR `C LL I U `J
ADDRESS CO CT[ON DATA
CITY Te Q7 STATION O D[PTN
LTATeuPPEn
MANHOL(REFERENCE <
REGISTRATION NO � � e COUNTY
No DESCRIPTION OF WORK FEE TYPE OF CONNERI LGTH Pn
HOUSE SEWER CONN[CTINO TO ' Y CURB PL M L TO P L
J PUBLIC SEWER O S.OO o-�
SEPTIC TANK SIEPAG[PIT OR Q JOS NO
P c NO III
PITS AND/OR GR
C LIG 00 CO IMP NO
HOUBE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM C L300 1
CONN ECT ADDITIONAL SLDO OR }n A FIDA VIT �n ....... RECORD INSTR NO DAT[
WORK TO HOUSE SEWER Y 53W 6� �/
OVERFLOW SEEPAGE PIT GRAINFIELD
LATH CESSPOOL DRYW[LL MANHOLE O LS OO
LTER R AIR OR ABANDON HOUSE NWY GRIST WIDENING
A
SEWER OR DISPOSAL SYST M 0 4300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERbUT s z o0
AUTHORMATION I TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE H[R[IN NAMED CON REIMBURSEMENT F[[
H
TRACTOR TO CONNECT THE ABOVE DLSCRIB(O IBTI 1�T�T�
TO THE PUBLIC SEWER APPROVALS OAT INSPECTORS SIGNATURE
SIGNED THIS DyI�OF V 1
OWNER OR /��/J-I[► � NEW HOUSt SEWER A�
OWNERS AGENT111CCC CONNECT ADDITIONAL /
BUILDING OR WORK //
ADDRESS
I N6RlSY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 6EPTIC TANK SEEP PI )
AND/OR GRAINFIELD
AND STATE THAT THE ABOVE IB CORRECT ANO AORE[ TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL Cl DRYW[LL ❑
1 H[RLBY CERTIFY THA PRORAW- F
[RED NO/OR ALTER REPAIR SKWEROR
LIC[NSEO AS R[OUIR[O Y • wNGLEAND S ATL OP BBWAOE OISPO{AL SYSTEM
GLIFOfl MIA OR THA AM E'L[GAL OAM I ENO TO OISCONN6CT PLUG AND
R"'OK 11 THC A D CRIKO R[SIP C Y ABANDON HOU Sl BEW[R
SIGNATURE BACKFILL 6EPTIC TANK{
OF P[RYRTEE SCEP ITI
8) ❑ CESSPOOLS y
` VALIDATION ROBERT A WOOD
R
CM O DASH SUPERVISING MECHANICAL ENGINEER
LAC0 7 2 2 9Q JUL 9 1 0 D 10.00- N