HomeMy Public PortalAbout5062 SULTANA AVE_Sewer__ 44650 INSM; '
7=800 a 0AG41D ° APPLICATION FOR PERM I
COUNTY OF LOS ANGELES SEWERJS AGE DISPOSAL
DEPABTbEENT OF COUNTY ENGINEER
' IEN • army• lBUILDING AND SAFETY DMSION ADDRESS
YffiLLAMNfH4.0 !.
—
LOCALITY
NEAREST ! F
FOR APPLICANT TO FILL IN CROSS BY
LEGAL
DESCRIPTION LOT H /.o OWNER
BLOCK TRACT o116 / MAIL
ADDRESS
NO OF BLDGS
SIZE OF LAT NOW ON LOT CITY TEL NO
U9EOF DISTRICT NO GROUP MAP PROC BY
BUILDIN64
o s B`
CONTRACTOR
ADDRESS CONNECTION DATA '
CITY TEL NO STATION 0 DEPTH
ST
ATE MANHOLE REFERENCE 0.EG19TRATIO MO COUNTY W
No I DESCRIPTION OF WORK FEE
ROUSE 9 WER CONNECTING TO
PUBLIC SEWER S 00 TYPE OF CONMG�CTIO LENGTH FROM /
SEPTIC TANK SEEPAGE PIT OR T CURB L Y L TO P L
PITS AND/ORD INFIELD 33 Q9
OVERFLOW SEEPAGE PIT DRAINFlELD
DRYWE Z 00
HOUSE SEWER CONNECTIpG TO IP
C NO
PRIVATE
DI EY I 0 CO 14P NO JOB NO
CCONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PmiYR NO
NORK TO HOUSE SEWER
ATR EPAIROR ABAND X HOUSE L STATE ENCROACHMENT Ip
DISSYSTPER T NO
INDUST
WASTE APPROVA
CHARGES
OWNERS PERM@ P 00 CONNECT CHARGE FEE
AUTHORIZATION TOTAL FEE O REIMBURSEMENT FI HAVE AT CE
NAMED CON-
TRACTOR TO CIONMECT THE S DATE A FBOYE DEeCRCT WITH TED ETIHE STMNG DWELLING APPROVALS DA �INSPECTOR 3SIGNATU0.E
TO THE PUBLIC
SIGNED THISAY OF 9 NEW HOUSE SEWER I fl/ f/T/l.Q.✓
OWNER OR 1 CONNECT ADDITIONAL
OWN
AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - - -
AXD STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE 'LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE REPAIR
DISPOS SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED A9 REQUIRED BY LOB ANGELS COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT 1 Y THE L HER OF THE ABOVE
WER
DESCRIBED RESIDENTI PER TT BACKFILLSEPT CTAXK9LJ
SIGNATURE SEEP PITS CESSPOOLS OF PERYI E
�F ATION ROBERT A WOOD
cAra SUP6RVLSING McCINANICAL BNOINKER _
X05 8 6 e DEE 8 1 O D 5.00 A
DEPARTAfIMNT OF GOU= ENGDn= SEWER—SEWAGE DISPOSAL 1
qlmmp ION OF BUMDING AND SAFETY PERMIT APPLICATION
OOUNTY OF LOB AN0ELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING O
ADDRESS
FOR APPLICANT TO LL IN LOCALITY
ADDRESSILDING n RRoSS� L /Y
LOCALITY DISTRICT SO Rub Tor IorpmHom PERMIT MO
NEAREST 36 '/07. s
CRO88 ST
RECEIVED BY DATE ISSUEDBY, DATE
OWNER
PAIL USE ZONE OCCUPANCY BK MAP PB
ADDRESS
CITY TEL N0. /) !a//:"L!�
CONTRACTOR CO-IMP NO
13 7
ADDRESS 5 �f$N,v
/ JOB.MO
CITY TELNO Ul6 TRUNK PERMIT NO
8TATE
pEOISTRATI NO COUNT' ROAD PERMIT NO
LEGAL }
DESCRIPTION LOT NO
/ STATE ENCROACHMENT
�/ PERMIT NO
BLOCK TRACT 5 / ' �_3 -INDUSTRIAL
WASTE APPROVAL
812E OF LOTNO OF BLDOS.
MOW ON LOT CHARGES
BUILDINGS OF CONN IOM CHARGE FEE
NO DESCRIPTION OF W K FEE
H ULE BEW ERC ME IND
PUBLIC SEWER @ SBS RECEIPT NO GATE BY
SEW ER CO
PRIVATE
TO REIMBURBEM EE
PRIVATE DISPOSAL SYSTEM 100
�b NNECDADDITIONAL BLDG.OR i EXCEPTION REDOR
WORK TO HOUSE SEWER 100 tl0
T 08 p� EPAIR EXISTING DATE B
_ SEWER 08 DISPOSAL SYSTEM 100 _
DIBCOMMECT AND ABAND11 NSEW R
ANO OR DISPOSAL SYSTEM 1 00 le, CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR yc
PITS ANO OR GRAINFIELD 220 STATION � �9 a� DEPTH
CESSPOOL-08YWELL
6PECIAL CONDITIOMB ON LY 200 FERENCE
P E
Y TYPE 0 C qB ECTIONP LEL TO PFROY
OWNERS PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE` OCA
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO T PUBLIC SEWER
SIGNED THIS Y OF191
NEW XOUBE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDINGORWORK
`o /7 {� SEPTICTANK BEEP PIT(8)
ADDRESS �d��_ '�•� • AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI-' CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSALTER REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. BEWARE EPAIR,SE SYSTEM
1 HEREBY CERTIFY THAT 1 AN -�"��"�"'
BY LOB ANGELES COON PLUG AND
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN. ABANDON HOUSE SEWER
EN OF THE ABOVE D RIBED BESIDERTIAL PROPERTY. A�ZC YfLLae 11 II""'T�
SIGNATURE SEEPPIT(8)o CESSPOOLS
OF PERMITTEE
76A643D S68 603 4/64