HomeMy Public PortalAbout5057 SULTANA AVE_Sewer__ emit an APPLICATION' FOR PERMIT
DIVISION OF B=ING AND SAFETY SEWER-SEWAGE DISPOSAL 1
. Depacrlmant of County Englnow
County of Los Angeles eDILDIxa
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASBATT O GRIFFIN SUP TOP BUILDING LOCALITY
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FOR APPLICAN T IN c9os3 SST
LEGAL �� OWNER
DESCRIPTION NO
OF MAIL
BLOCK TRACT r. e-1 .. /Z 3 ADDRESS
I
+ N -O BLDG! CITY t\ TEL NO
SIZE OF LOT NOW ON LOT
USE
BUILDINGS DISTRICT NO GROUP YAP
BK PO
CONTRACTOR
ADDRESS CONNECTION DATA
STATION I DEPTH
CITY14n-92 r TEL NO MANHOLE REFERENCE ER
STATE LOWER
REGISTRATION NO ❑ COUNTY �
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNEN LENGTH FR
PUBLIC SEWER S 3 50 Y CURB P L Y L TO P
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® 7 3 00
OVERFLOW SEEPAGE IT DRKT1RfLLD
8200 CO IVP NO XO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD RUST NO
CON N ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® f 100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER$ PEEMIT f 1 00 1IJJJ1
AUTHORTLATION TOTAL PEE 3 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR]SIGNATURE
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 SEPTIC TANK SEEP PIT(S) A
ADDRESS AND/OR GRAINFIELD A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL,[J'DRYNELL❑
AND STATE THAT THE ABOVE IS-CORRECT AND AGREE TO COMPLY i
WITH ALL COUNTY ORDINANCES 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 AND STATE OF ABANDON CT PLUG AND
CALIFORNIA OR THA I AY T E G OWNER OF THE BOVEHOUSE
DESCRIBED RESIDE T A PROP Y BACKFILL
AC FIL (S)P❑ CESSPOTICTANKS O❑
SIGNATURE
OF PERMITTEE gel
JOHN A L.AMBIE COON NGINEER j ALIDATION ROBERT A WOOD CHIEF PLSG INSPECTOR '
CK Y O GSH
[�4402� JAN22 4 3.00
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL�I
DEPARnum OF COUNTY ENGINEER
BUU.DING AND SAFETY DIVWON BUILDING _ O
L�I�1 A Lll2 Cot � ADDRESS _
c�Sanxr a as>rFw, S,a 1 �1 mtm*o LOC,uTT
FOR AR
ILL IN "cxosssr
LEGAL
DESCRIPTION LOT NOWNER
BLOCK TRACMAIL -
ADDRESS
1� 1T7LDISTRICT NO GROUP YAP
CONTRACTOR � BK PG
ADDRESS 'CpO�NNECnON DATA
CI PA STATION ,3 p DEPTH
RE613TRATION NOCOUNTYMANHOLE REFERENCE ! S C L.,�xo DESCRIP IOEOUSE SEWER CONPUBLIC SEWERf 3 OD
SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION iRMOTH FR
PITS AND/OR DRAINFIELD $3 00 T CURB P L Y L TOP
LOU
OVERFLOW SEEPAGE PIT GRAINFIELD
EKTH CESSPOOL DRYWELL MANHOLE E 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO OO JOB NO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER 1 00 TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAIR ORABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
' - WASTE APPROVAL
WWW - CHARGES
O VY���+�a•u S PERMIT S OO CONNECTION CHARGE FEE ^
AUTHORIZATION TOTAL.EEE— —s' co
REIMBURSEMENT FEE
CN
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING"MED DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER _ _ _
SIGNED TRI' DAY OF 79 NEW HOUSE SEWERY-301 97.
OWNER OR _ _ _ - - CONNECT ADDITIONAL - - - -
OWNER9AGENT-y BUILDING OR WORK
(� SEPTICTANK BEEP PIT(S)
- -
AOORE9 FANO/OR DRAINFIELD f
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION L .L
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO-COMPLY CESSPOOL 0 ORYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED-AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED SY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THA AY THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED REBID R ERTT - BACKFILL SGS
SIGNATURE CESSPOOLS
OF PERYITTE
AlDATION ROBERT p:-WOOD- _
QK _Y 0 CASH SUPERVISING MECHANICAL ENGINEER
— - -
M5 7 7 O a; APR 27 1 o A_ 5:00
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