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HomeMy Public PortalAbout5521 SULTANA AVE_Sewer__ S&K 06311 APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL DePtarttsat of County Engfnea County of Las Angelos Bu1LDInG,/� I JOHN A LAMBIE COUNTY ENGINEER ADDRE9! V m CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FFOOR�APP.ICANT FILL. IN CROSS SST ,y LEGAL A m(/ ` -IV DESCRIPTION LOT X OWNER MAIL BLOCK TRACT ADDRESS X OP BI OT ft /_-� CITY �• TEL NO SIZE OF LOT 'L NOW ON LOT /•L� A/'3 USE INGS DISTRICT NO GROUP YAP USE OF BK PG CONTRACTOR A f ADDRESSd CONNECTION DATA CITY SIA TEL NO _ Q �! STATION DEPTH , J .MANHOLE REFERENCE UPPER TATE LOWER REGISTRATION NO � COUNT' NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TOTYPE OF ONNECTION LENGTH FROM PUBLIC SEWER @ $3 SO Y RB P L M L TO 'L SEPTIC TANK SEEPAGE PIT OR VEXTN ITS AND/OR DRAINFIELD $3 00 VERFLOW SEEPAGE PIT,DRAT NFIELD • CO IMP NO JOB MO CESSPOOL DRYWELL,MANHOLES200OUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® S 100 TRUN�PCRMITNO AO PERMIT NO CONNECT ADDITIONAL BLDG OR STATWORK TO HOUSE SEWER S 1 00 PERM •�^" ALTER REPAIR OR ABANDON HOUSE INDUSTRIA SEWER OR DISPOSAL SYSTEM S I OO IN AP OVAL CHARGES CONNECTION CHARGE FEE OWNER'S PnmT s 1 00 AUTHORATION TOTAL FEE OL J � REINBURSEYEMT FEE IZ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COX APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DES CRI D EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER SIGNED THI DAY 19_ CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT I' SEPTICTANK SEEP PIT(!) ADORE AMD/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I 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 !EWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I 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 AY HE LEGA WNER OF THE ABOVE DESCRIBED RESIDENTIAL PR RTY BACKFILL SEPTIC TANK!❑ SIGNATURE LEEP PIT(S)0J CESSPOOLS OF PERYITT JOHN A LAMBIE COUNTY ENGINEER ©VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR Y 0. CA�tl M7.933—� MAY 8 4 , 2.00