HomeMy Public PortalAbout5330 SULTANA AVE_Sewer__ isK 60311 BB APPLICATION FOR PERMIT
DWISION OF HUBMING AND SAFETY SEWER-SEWAGE DISPOSAL
DBPartimsent of County Engineer _
County of LOB Angel" BUILDIADDRESNG
O ' U L N
JOHN A LAMBIE COUNTY ENGINEER /�
m CASSATT E) GRIFFIN SUP T OP BUILDING LOCALITY ` J'
FOR APPLAREST ICANT TO FII1 IN N OBS ST IV "
LEGAL ^ r OWNS
DESCRIPTION LOT NO i 7 lot JIT,
MAIL
BLOCK leTRACT / 'ADDREB'{l3jO S & t7'.4Nfi
NO OF BLDGS CITY TEL NO A/TE
SIZE OF LOT NOW ON LOT
USE DI DISTRICT NO GROUP YAP
USE OF
SB( PG
CONTRACTOR �
ADDRESS
- -CONNE=ON DATA
CR .ZBn SA
Y TEL NO STATION , DEPTH
MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRATION NO ❑ COUNTY m
No I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO CURB L TYPE OF CONNEC ONP •LENGTH FROM /
L Y L TOP
PUBLIC SEWER ® $3 SO Y
SEPTIC TARN SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD 7 7 P C NO
EKTN CESSPOOL DRYWELL,MANNOLE ® $r 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO h
PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO ID
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S FEDUT s I Oo
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPE TURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF I9— CONNECT ADDITIONAL /
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTICTANK SEEP,PIT(S)
ADDRESS AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGETHAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTAL PROPERTY /'� BACKFILL SEPTIC TAXRS❑
SIGNATU RE ...� K SEEP PIT l6) ❑ CESSPOOLS
OF PERMITTEE V
JOHN A IJAMBIE COUNTY ENGINEER VALIDATIONROBERT A WOOD CHIEF PLSG INSPECTOR
1 LAC.2 602 `".H 14 4 A 450