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Home My Public Portal About5073 SULTANA AVE_Sewer__ 76 64ID-CE/06 -10-71 APPLICATION FOk PE IT COUNTY OF LOS ANGELES SEWER-SEWAGE=P AL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS LOCALITY FOR APPLICANT TO FILL IN NEAREST cRo[S ST LEGAL DESCRIPTION LOT NO Q ` OWN(R MAIL BLOCK TRACT AO NO 01 pLDGS SIZE OF LOT NOW ON LOT CI TEL NO USE OF SK pUILDIN08 DISTRICT NO GROUP MAR PROC E!!EO BY CONTRACTOR [ v � 1/ ✓/ Ao CONNECTION DATA CI Y STATION DEPTH STAT[ LIC MA N HOLE REFERENCE UPPER LICENSE NO CLASS LOWER NO DESCRIPTION OF WORK FEE TY P[OF CONX[RIONL[XGTH FROM HOUSE SEWER CONNECTING TO Y CURB FLA M L TO P L PUBLIC SEWER 0 $7 00 SEPTIC I-AN K SEEPAGE PIT OR C NO PITS AND/OR D.A.NFI CLD 0 EI000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO V r PRIVATE DISPOSAL SYSTEM 0 33W ROAD PERMIT NO O CONNECT ADDITIONAL BLDG OR AIII DA VIT uv RECORD INSTR XO DATe V WORK TO HOUSE SEWER 0 5300 Od OVERFLOW SEEPAGE PIT GRAINFIELD OC [ETN CESSPOOL DRYWELL 0 E600 HWY OR 6T WIDENS O ALTER REPAIR OR ABANDON HOUSEty' SEWER OR DISPOSAL SYSTEM 0 $3 00 :TAT[ENCROACH NT MANHOLE O $J 00 PEHI'IIT NO 1 IMDU9140 TRIAL ��TT��..�� WAST[APPROVAL OY11YmsFE9 U f 3 00 CHARGES AUTHORIZATION TOTAL FEE & CONNECTION CHARGE FE[ 1 HAVE AT THIS DATE A CONTRACT WITH THE MERLIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ASOVE DE BEO TIN Q DWS TO THE PUSLIC SEWER APPROVALS DAT[ INSPECTOR S SIGNATURE SIGNED THIS AY O )� OWNER ORit [ NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK EEFTIC TANK SEEP PIT(G) 1 HEREBY STATE THAT TH ABODGE TH I HAVE READ THIS AP LIGATION AMO/OR DRAI NFIELD AN STATE THAT TH[ ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ HERESY CERTIFY T I AM OPEN R[OIST D AND OR ALTER REPAIR SEWER OR LICENSED AS REOUIR SY L0IS ANG OU NY, STATE 01 SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH 1 TN[ LEGA O R OF A INTEND TO 016 "NEC T PLUG ANO RESIDE IN THE CRI SEO IAL TY ALC ON HO US[S[W ER SIGNATUR pACKFILL SEPTI ❑ OF PERMFTTt[ :ECP ILLS C 0 Q/ VALIDATION cK M 0 CASH i - LAW 9 2 4 3; r s_ o D 6.00- Q 1 Tan aAZD-ceeoe -IaTI APPLICATION FOR PERMI- , GC. � �� it COUNTY OF LOB ANGELES SEWER-SEWAGE'MBPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONfADDR LDING Sd RLBB ALITY L FOR APPLICANT TO FILL IN �e DT LROAL DESCRIPTION LOT NO NER L BLOCK TRACT ISeNO OF PLOT pIZ[ OF LOT NOW OX LOT Y T[L NO USE OF f pUILDINOs S� DIeTRICT NO GROUP MAP CE88C0 aV e[ PS CONTRACTOR Fd$ � ADDRESS O/NNE�CTION DATA STATION 8�// DEPTH STATE LIC MANHOLE REFERENCE' /75 4 n PIYR LICENSE NO OLAps v }' LOWER No DESCRIPTION OF WORK F[[ IS TYPE OF CONNECTION LENGTH FROM O OUSE SEWER CONNECTING TO7['ORST CURE L M L TO P L PUBLIC SEWER 0 fT 00 SEPTIC TANK SEEPAGE PIT OR 'M PC "O PITS AND/OR GRAINFIELD O BID Go P NO JOS NO HOUSE SEWER CONNECTING TO PERMIT NO ROAD PERMIT NO D• PRIVATE DISPOSAL SYSTEM 0 Se 00 O CONNECT ADDITIONAL OLDO OR AVIT tMV„ .A,I..R, RECORD INBTR NO DAT[ U WORKTO HOUSE SEWER O 5800 OVERFLOW SEEPAGE PIT GRAINFIELD O [[TN C[pSPOOL OflYW[LL O $900 WIDENING ALTER REPAIR OR ABANDON HOU.! SEWER OR DISPOSAL SYSTEM 0 5800 STATE ENCROACHMENT MANHOLE 0 $T 00 PERMIT NO 0_ INDUSTRIAL OWNER'S APPROVAL Z O��nNER'S PEENDT S 8 00 CHARGES AUTHORIZATION I TOTAL FEE la too CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WIT T ! REIN NAMED CON REIMBURSEMENT FEE TRACTOR To CONNECT THE ABOV. D[ RI 1 E O p p *� TO THC PUBLIC SEWER APPROVAIS DAT[ I ECTOfl SIGNATURE SIGNED THIS D OF ....... ` NEW HOUSE SEWER OWNI..AO.NT CONNECT ADDITIONAL AOORIps BUILDING OR WORK 81PTIC TANKBEEP PIT(S) 1 HEREBY ACKNOWLEDGE THAT I'IMVE READ THIS APPLICA ON AND/OR DRAI NFIELD ANO ALL THAT TX[ ABOVE ICORRECT AND AGREE COMPLY WITHAALL COUNTY ORDINANCES AND STATE LAWp REGULATING PLUM B ING AND SEWERS CESSPOOL ❑ pRYW[LL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES Y A STAT[ OF SEWAOC DISPOSAL SYSTEM CALIFORNIA OR THAT 1 M THE LEGAL OWN A INTEND TO DISCONNECT PLUG AND RESIDE IN THC ABOV ESCRISEO R IDLN AL R TY ABANDON HOUSE SEWER SIGNATURE OF PCRMTTTE PTIC TANNB BEEP PIT(g) l.. LB VALIDATION cR q cABK LAC07 6 1 7;S AW16 1 0 0 1 0.00- � OAK 663 IS eA APPLICATION FOR PERMIT 1 DrvimON OF BUMDING AND sAFErx SEWER—SEWAGE DISPOSAL D.purimBat of CGGntp >��.w Co=tp cI IAB AY9eloB AD LD NG O WM J FOX, COUNTY ENa1NBER SS CAYBATT D GRIFFIN SUPT OF SUILDINO LOCALITY FA APPLICANT TO FILL IN NEAREST CROSS ST --� T NO OWNER ACT ]/�� . MAILADNESS NO OF BLDGS NOW ON LOT CITY TEL NO DISTRICT NO GROUP YAP e S BK -° CONTRALTO _ ADDRESS ' CONNECTION DATA CITY TEL NO 3 O STATION DEPTH HOLE REGISTR TION NO 0 COUNTY MA UPPER REFERENCE LOWER /�9O/� TYPE OF CONNECTION LENGTH FROM No DESCRIPTION OF WORK FEE r CURB P L M L TO P L HOUSE SEWER CONNECTING TO _ PUBLIC SEWER ® f S BO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO WORK TO HOUSE SEWER 1 DO _ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 DO TRUNK PERMIT NO ROAD PERMIT No ,DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PEAYIT NO SEEPAGE PIT OR PITS AND/OR GRAINFIELD 200 INDUSTRIAL CESSPOOL DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 3 00 CHARGES CONNECTION CHARGE FEE OWNER'S pmib= s 1 00 AUTHORIZATION TOTAL FEE 400REIYBURSEYfi NT FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON + TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER , SIGNED THISDAY OF NEW HOUSE SEWER 19— OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK SEEP PIT(S) ADDRESS - AND/OR DRAINF 0 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL YWELL❑ LI 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 I AN PROPERLY REGISTERED AND/OR LUG AND P LICENSED AS PEOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT ABANDON HOSE SEWER CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPBKS TANKS❑ - SEEP PITS CE68POOLS SIGNATURE OP PERMITTEE WIWAM J FOX.CouNTY ENa1Nt= - - - VALIDATION By ---,-.,&0'378M NW29. -a - 3A0 a DEPUTY DEPUTY BY BY �E [[/'@T�y B DEPUTY DEPUTY P�17