HomeMy Public PortalAbout5050 SULTANA AVE_Sewer__ 11385
el G Gas 11 ss APPLICATION FOR PERMIT 1
DMSION OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depourtment of County Engineer
County of Los Angeles BUILDING 'v
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASSATTD GRIFFIN 9UPTOPSUILDIND
LOCALITY �K
FOR APPLICANT TO FIU IN c OSS s 1
LEGAL L
DESCRIPTION LOT tl 3 / Z OWNER
PAIL
BLOCK AMT620. ck �� ADDRESS
NO OF BLDG! / CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO GROUP YAP
BUILDINGS _Z7
/T A BKPO
CONTRACTOR CALIF.SEWER CONST CO
ADDRESS
1317 COLEGROVE AVE. CONNECTION DATA
CITY MONTEBELL41. NO PA 1-5048 STATION DEPTH
MANHOLE REFERENCE UPP
u ❑ STATE
REGISTRATION NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE!EWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
Py T CURB P L Y L TOP L
PUBLICSEWER 0 s
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q S 3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
IXTH CESSPOOL DgTW ELI YMrif S 2 00 CO IMP NO �. JOS NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® 31 00 TRUNK PERMIT NO ROAD PER
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 100 PER T NO
ALTER REPAIR OR ABANDON HOUSE IMOU AL
SEWER OR DISPOSAL SYSTEM
® 1 00 WASTE A14MOVAL
CHARGES
CON! TION CHARGE FEE
OWNER'S pEaanT s o -
AUTHORIZATION TOTAL FEE REIMBURlEYENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �D ••
TO THE PUBLIC SEWER NEW HOUSE SEWER`
SIGNED THI DAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK SEEP,PIT(!)
ADDRES AND/OR DRAINFIELD -
1 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 ALTER.REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRE0 BY LOS GELES C UN AND 9 ATE OF
CALIFORNIA OR THAT 1 AN GAL N OF T ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL P ERTY BACKFILL SBPRC4SSPOM&
SIGNATURE CESSPOOL!
OF PERMITTEE `
JOHN A LAMBIE COUNTY EN GI VALIDATION ROBERT A WOOD Cli�fl Ecroa
(�586OR APR 291 0 A . 5.00