HomeMy Public PortalAbout5128 SULTANA AVE_Sewer__ I
DErAxrDMgT OF COUNTY ENGONE21M _ SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILMING AND SAFETY PERMIT APPLICATION
` COUNTY OF LOS ANGIU,
WILLIAM J. FOX, COUNTY ENGINEER ' BUILD NO /B SGLZZ t�
ADDRESS
FOR A ICANT O FI L IN - LOCALITY y�
BUILDING MEANEST
ADDRESS CROSS ST 5e.1110 5e."4 7O
LOCALITY DINTRIOi NO SERIAL NO PERMIT NO
NEAREST L!!�_ 141040-?2111 Q S
CROSS ST
RECEIVED BY Rsft/N 1agwUM DATE ISSUED
OWNER
Y✓'-n �./
TAIL USEZONE OCCUPANCY YAP
ADORESS 8K PS
CITY &rITQL NO
CONTRACTOR Y _ A
O CO IMP NO � /'1
ADDRESS G ` �;
e JOB NO �—
CITY TEL NO C L (�6 TRUNK PERMIT NO
3// 9-3 TATE
REGISTRATION NO �-Y COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO
STATE ENCROACNIIEYT
t �? P[RYIT NO
BLOCK TRACT �� �� �./- W DUSTRISTE PROVAL
SIZE OF LOT NO OF BLOBS
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSESEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER ® $ 870 RECEIPT NO DATE BY
1 HO USE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR a 0 EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO I DATE - JOY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON NEWER
AND/OR DISPOSAL SYSTEM 100 - CONNECTION DATA
SEPTIC TANK SEEPAGE I R ,� '
PITS AND/Ofl GRAINFIELD 200 STATION 2 DEPTH
ROSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 �IAWHOOLLEE REFERENCE LOWER
UR TYPE OFF C10NNN'ECTTIION LENGTH FROM
OWNERS PERMIT $ 1 00 Y CURB P L MIL TOP L
AUTHORIZATION TOTAL FEE ,Z D6
I HAVE THIS DATE CONTRACTED WITH THE NEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19— , NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ____ _ __ __ _ —_ _ _ __ _ BUILDING OR WORK
SEPTICTANKSEEP PIT(S)
AODRE86
-AND/ORD RAI RIFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL❑ DRYWELL 0
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUS AND
AMO/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY c
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTICTANKS
11''II
SIGNATURE //J ,�// SEEP PIT(B) CESSPOOLS
OF PERMITTEEL..r.
TSAN2D SSS 1/07