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Home My Public Portal About5080 SULTANA AVE_Sewer__ CESOBL' Te.eA7,C� ,?'� APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTNlEINT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONj DINa 4 WMALAW= COESS VVLJ.IAM A IENM SrMD` B! &Ild{Df r LITY EST FOR APPLICANT TO FILL�B IN [ ST LEGAL 1 OESCRIPT ON LOT N rr(.Q eR—/Z �/BLOCK TRACT "p NO OI BLDG[ SIZE OFLOT NOW ON LOT CITY UBE OF 01, DISTRICT N ROUP PROC [D BY st a• r B Pa CONTRACTOR vl O ADDRESS CONNECTION DATA CITY TSTATION DEPTH STAT[ MAHNOL[R[F[R[NC[ UPPER REGISTRATION NO COUNTY LOWER NO DESCRIPTION OF WORK IBE TYP GR [CTI HOUSE SEWER CONNECTING TO Y L m, PUBLIC SEWER O 8300 _ PC NO PTC TANK SEEPAGE PIT ORY ITS AND/OR ORAINPI ELO O SIO 00 CO IMP NO JOS NO 0- HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM O SSW CONNECT ADDITIONAL SLOG OR AFFIDAVIT I SAN91 211I09IT RECORD INS" NO DATE O< WORK TO HOUSE SEWER O B300 O OVERFLOW[[[PAGE PIT GRAINFIELD [[TN CESSPOOL DRYWELL MANHOLE O BE GD ALTERO HWY QRST WIDENING SEWER OR DISPOSAL SYS M O {f 00 STAT[ENCROACHMENT PERMIT NO Z INDUSTRIAL WASTE APPROVAL CHARD" rA R$ PERMIT s o0 ATION 'TOTAL FEE CONNECTION CHARGE FEE IS DATE A CONTRACT WITH THE HEREIN NAMEDCONREIMBURSEMENT FEE CONNECT THE ABOVE DESCRIBED B[ISTINO DWELLING APPROVAL$ IC f[WEfl • DAT[ INW¢CTOR/SIGNATURE S DAY OF IG_ NEW NOUS[SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEOG[ THAT 1 HAVE READ THIS A"LIGTION SEPTIC TANK SKIP PIT(S) ANO STAT[ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYD/OR GRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS R[OULATINO PLU MSINO AND [EWERS ¢POOL ❑ DRYW[LL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OFACK DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO PLUG AND RESIDE IN THE A VE DESCRIp RESIDENT, W[ 41 SIGNATURE r NDON NOUS[6L\YER OFPERMITTRFIIT SEPT C TANSS F PIT181 U c["Poou ATION ROBERT A WOOD (:::CEKM D CASH SUPERVISING MECHANICAL ENGINEER _fN_0 5 8 5 P ' SEP 2 3 1 J 0 5.00— s 7@A"20 @A"all EE APPLICATION FOR PERMIT 5010 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1 D.ambamt of County Englnsu County of LO{ AnYeLs ADDRESS G • L/ JOHN A LAMBIE COUNTY ENGINEER ` m CAWATTD GRIFFIN SUPTOFBUILDINO LOCALITY FOR APPLICANT TO FILL IN CROSSSSST LEGALA2 w1O L.ql d DESCRIPTION NO _U C MAVEN MAIL If BLOCK TRACT ` � �� ADDRESS NO OF BLDGS CITY TEL NO SIZE OF LOT NOW ON LOT USE OF DISTRICT 0 6ROI�P YAP BUILDING! ..Y/T_ ,{J ft [ BK P CONTRACTOR ADDRESS 17 OLEO V CIO )N DA A CITY MON TEBE Lf3L NO _ Oqg STATION DEPTH MANHOLE REFERENCE C REGISTRATION NO �A� ❑ STATE J LOWE ❑ COUNTY No DESCRIPTION OF WORK FEE HOUSE SEWER COX TING TO TYPE OF CONNECTIOl, LENGTH FROM �J PUBLIC SEWER ' @ S S Q Z{ Y CURB L Y LEN TOP L Z d SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® f S 00 OVERFLOW SEEPAGE PIT DRAINFIELD P C MO EXTN CESSPOOL DRYWELL MANHOLE ® f E 00 Co IMP NO X100 JOB NO _ HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® $1 00 �TRUXK PER NG ROAD PERMIT X ENCWORK TO HOUSE SEWER CONNECT ADDITIONAL BLOG OR ® f 100 PERSA MIT NOR CXYENT ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL SEVER OR DISPOSAL SYSTEM ® S 100 WASTE APPROVAL CHARGES CONNECTION RGE FEE' [ADDROWNER'S PERMIT s 00 ESS THORIZATION TOTAL YEP REIMBURSEMENT FEE VE AT THIS DATE�A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING HE PUBLIC SEWER NEW HOUSE SEWER 0 ED THIS DAY OF 19 CONNECT ADDITIONAL ER OR / BUILDING OR WORK ERS AGENT 10) SEPTIC TANK SEEP PITS) ESS AND/OR DRAINFIELD EREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIONCESSPOOL❑ DRYWELL❑STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR BING AND SEWERS SEWAGE DISPOSAL SYSTEM HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND NSED ASREQUIREDBY LO NGEL S CO TY AND TATE OFFORNIA ORTHAT1 H LEG 0 N R OF T ABOVE ABANDONMOUSE SEWER RIBEDRESIDENTIAL OPERBACKFILL fifR}C'I'RRR�ATUREPERMITTEE JOHN A LAMBIE COUNTY c E OVALIDATION ROBERT A WOOD C1 Gr s GR Y D GABA MD5 8 6 IA APR 29 1 0 A. 5.00 � • �is,Glc�rx/ aaB;ell „ APPLICATION FOR PERMIT 1 DMSION OF BUIWDFG AND SAFETY SEWER—SEWA E DISPOSAL Dopmbnmzt of Comty Enpinew Comity of Las An"I" BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS O m CASSATT D GRIFFIN SUP TOF BUILDING LOCALITY FOR APPLICANT TO FILL IN "E0REST " LEGAL DESCRIPTION LOT NO OWNE BLOCK TRACT PAIL ADDRESS NO OF BLOGSCITY TEL NO SIZE OF LOT NOV ON LOTT USE OF . DISTRICT MO GROUP YAP BUILDINGS BK PO CONTRACTOR ADDRESS CONNECTION DATA a STATION DEPTH CI NO MANHOLE REFERENCE - A P ��YY ®STATE REGISTRATION NO O 0`- ❑ COUNTY No DESCRIPTION OF WORK FEE - IIOUSESEWER CONNECTING TO TYPE OF CONNECTION NGTX FROM I PUBLIC SEWER ® S 9 Qd Y CURB Y L TOP L SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® $3 00 OVERFLOW SEEPAGE PIT DRAINFIELDCO IMP NO n m IDB No EKTN CESSPOOL,DRYWELL MANHOLE S 2 00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO CON NECT ADDITIONAL WORK TO HOUSE SEWER BLDG OR ® III 00 PERMIT STATE ENCROACHMENT ALTER REPAIR OR ABANDONHOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM ® 1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE ovim's PmwT $ ;t DD AUTHORIZATION TorAL FEE d REIYB URSEY ENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR 5SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEW NEN "OUSE SEWER SIGNED THI DAY OF 79 CONNECT ADDITIONAL OWNER OR T BUILDING OR WORK /r 0OWNERS AGENT AND/OR SEEP,PIT(S)ADDRES AND/OR DRAINFIELD ^n 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 ALTER,REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT i A" THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEOT L OP RTY BACSEEP FILLPITSEPT EANKS a❑ SIGNATURE L7 C OF PERMITTEE - JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR - C[ Y 0 CAAH M57690% APR271 0 A 5.00 19 ?,41)f '7