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Home My Public Portal About5335 SULTANA AVE_Sewer__ cEaos D,I!•SZ 70AG4 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE ISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING DBZI A LR]LB(E CQYB LOquLp ADDRESS A IEBS¢N SGP f of DuildlBq LOCAL TY CROSS S FOR APPLICANT TO IN cRoeE ereA L A DESCRIPTION LOT N OWNER MwIL f BLOCK Tfl6CT /� / ADOREIB h✓\� NO OF BLDOS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP NAP PROCESSED BY BUILDINGS BK q coerflwcro Jam?/J ADORES CONNEC'CIO ATA CI CL N �d ATION J- E"H REGISTRATION NO COUNTY MANHOLE R6FERCTXCE OWC NO DESCRIPTION OF WORK FEE TYPEOFCONNECTI N ' LINO RO Q HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L _ V PUBLIC SEWER O S5oo SEPTIC TANK SEEPAGE PIT OR PC NO on No PITS ANO/OR GRAINFIELD O slow CO IMP NO 0 HOUBE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT No PRIVATE DISPOSAL SYSTEM O $300 CONNECT ADDITIONAL BLDG OR ' AFFIDAVIT ..G.. �e�TRTv RLCORO INOTR NO DAT[ y WORKTO HOUSE SEWER O L300 z OVERFLOW SEEPAGE PIT GRAINFIELD [ETN CESSPOOL DRYWELL MANHOLE O $500 ALTER REPAIR OR ABANDON HOUSEHWY OR ST WIDENING S OR DISPOSAL SYSTEM O [900 STATE ENCROACHMENT PERMIT NO fFN STRIAL n TE APPROVAL CHARGES OWNER'S PERMIL s AUTHORIZATION TQTAL FEF NECTION CHARGE FEE ry I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDBURSEMENT FEETIIACTORTOCONNECT THE ABOVE DESCRIBED EXISTING DWITO THE PUBLIC SEWER APPROVALS DAT! INSPECTOR S SIGNATURE SIGNED THIS DAY OFOWNER OR HOUSEBEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION OPTIC TANK SEEP PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ANO/OR GRAINFIELD WITH ALL COUWYORDINANCES AND STAT! LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I/AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO OI6CONNECT PLUG AND RESIDE IN TNL V6 DlSCRI[CD R!B NTIA PROPERTY ABANDON HOUSE SEWER SIGNATURE BA<NFILL SHPTIC TANKS ❑ OF PERMITTEE SCEP PIT IB) ❑ CEDSPOOLS VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER DK t 89 �23DG Al61511 0 25.00,- q `EB°tl° °' D APPLICATION FOR PERMIT cmaos COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DrMION BUILDwG fOF4f A LAEIDIE County Enq iiw ADDRESS NRLLIAM A JENSEN Sup t of Building �� LOCALITY NEAREST FOR APPLi O IN `"°"• •T E°AL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT /� / AO°RISB NO OF SLOGS SIZE OF LOT NOW ON LOT CITY T[L NO aUI OF DI�1 O GROUP MAP P !O SY USE or 08 g CONTRACTOR ADDRESS CONNECrlON ATA CITY [L NO b�y 'TION �� DEPTH REGISTRATION NO COUNTY TATE MAXHOLE [FERENC[zws LOWER NO DESCRI I F WO FE[ TYPE OF CON [ L[NOTH FROM HOU S[SEWER CONNECTING TO Y P L ML TO P L V PUBLIC SEWER saw / PC NO O( SEPTIC TANK R SEEPAGE PIT OR CO IMP XO JOB NO \T! PITSANO/ORAINFIELD C EI00° HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d PRIVATE DISPOSAL SYSTEM 0 E9 co CONNECT ADD ITIONAL BLDG OR AFFIDAVIT I RNYE[I EASCUt"I RECORD INSTR NO DAT[ y WORK TO HOUSE SEWER Q saw OVERFLOW SEEPAGE PIT GRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE C ES DO HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 0 ES GO STAT[ENCROACHMENT PERMIT NO INDUSTRIAL WAiTE APPROVAL CHARGES OWNER'S PERMIT s 2 00 A YJ COHry[CTION CHARGE FEC AUTHOATLATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN .AMED COM REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED SE� LLIHE� _I�TING DWELLINOELLINGI�WTIN° DWELLING TO THE PU'LIC SEWER APPROVALS DAL IXMECTOR 88634ATURE SIGNED THIS DAY OF IS_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTICI HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR dU1NF1TANK E[E PIT(6) ANO STATE THAT THE ABOVE 18 CORRECT AND AOR[E TO COMPLY AND/OR WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING PLUMBING AND SEWERS CESSPOOL Cl DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER ON LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN TH[ A OESCRI D REBID IAL PERTY ABANDON HOUSE SEWER SIGNATURE ❑ OF FERMI TTE[ ACKFILL SEPTIC TANKS SEEP P1T(SI ❑ CLSSPOOL6 �j VALIDATION ROBERT A WOOD VM O CASH SUPERVISING MECHANICAL ENGINEER CN �ps92212 AIX1_ 5 1 0 D 7.00- 0