HomeMy Public PortalAbout5523 SULTANA AVE_Sewer__ is 9466311 ON APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1
Deyartmsat of County Engineer
County of Los Angeles BUaslsa MTELNO
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASSATT D GRIFFIN SUP T OF aUIIDINO LOCALITY
EST
FOR APPLICANT TO FILI IN CROSS SSTLEGAL �j OHNEDESCRIPTION 4OTNOW 6MAIL
BLOCK TR ADDRESSNO0 OOB CITY
SIZE OF LOT
No 0 LOT
di
USE OF - DISTRICT NO GROUP YAP
BUILDINGS r % ,ee
CONTRACTOR -
CONNECIION DATA
ADDRESS
CITY TEL NO STATION DEPTH
MANHOLE REFERENCE _ UPPER
❑ STATE _ LOWER
REGISTRATION NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LTH FROM
PUBLICSEWER @ Y CURB P L PINTo P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 0 S S 00
OVERFLOW SEEPAGEPIT DRAINFIELD P C NO
EKTX CESSPOOL DRYWELL MANHOLE ® SZ 00 CO INP NO JOB MO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® S 1 00 T RY
/ CON N ECT ADDITIONAL BLDG OR STA ACHMENT
WORK TO HOUSE SEWER ® $100 D pEA 0
ALTER REPAIR OR ABANDON HOUSE IND PIAL
SEWER OR DISPOSAL SYSTEM ® $100 WASTE APPROVAL
CHARGES
CORRECTION CHARGE FEE
OWNER'S PST s 00
ADTHOATION TOTAL FEF REIMBURSEMENT FEE
AIZ
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-, APPROVALS DATE INSPECTOR SSIGXAT URfi
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEN HOUSE SEWER
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK - O
OWNERS AGENT SEPTIC TANK SEEP,PITS)
ADORES" AND/OR DRAINFIELD
IH
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY RE TERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COU AXO STAT F
CALIFORNIA OR THAT 1 AY THE LEGA OWN R OF THE OVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTI PROPERTY • BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT($) El CESSPOOLS❑
OF PERYITTE At4
JOHN A L.AMBIE.CouN ENGINEER VALIDATIO ROBERT•A WOOD ClllEr PLUG INSPECTOR
CK Y 0 CAINI in
/�
.54 � T 210 A _ 3.000
SaR eso APPLICATION- FOR PERMIT 1
DIVIMON OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL +
DBpmlmeBl d Z:m Eogln*w
CwotT
of Las Aygelp BUILDING
WM J. FOX.COUNTY ENGINCBm ADDRESS
CASSATT D GRIMM,SU T or SURGING LOCALI7T
FOR APPLICANT TO IN xEAafisr
CRO! T
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL
"DRESS
NO BLDG!
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGSDISTRICT NO GROUP YAP
CONTRACTOR 1-" BK PO
I N `7
ADDRESS Z W d *� CONNECTION DATA
CITY F� /h 0-4, (I TEL NO QS STATION DEPTH
UPPER
REG13TRATZON NO ! / ❑ COUNTY YARHOLE REFfiREN E �• LOWER
NO DESCRIPTION OF WORK FTE
EE
HOUSE SEWER CONNECTING TO r / TYPE ECTION LENGTH FROM
PUBLIC SEWER (Rl S ] 80
s 7 T CURB P L M L TOP L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR P C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100I
PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS ANO/OR DRAINFIELD 300INDUSTRIAL
CES IPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
O�g Pte,
CONNECTION CHARGE FEE
5 !00
AUTSOR=TION TOTAL FEE7 'V REIMBURSEMENT FEE
I HAVE CON-
TRACTORTTOS CONNECT THE DATE AABOVE DESCRIBED EIICTED WITH THE ESTIN WELNEDCo
LING APPROVALS DATE INSP CTOR SSIGMATURE
TO THE PUBLIC SEWER
ED
SIGNED THIS nAY OF _ NEW HOUSE SEWER
OWNER OR nCONNECT ADDITIONAL
OWNERS AGEXT !� BUILDING OR WORK
ADDRESS100, SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGRMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE REPAIR,
DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISND/OR
LICENSED B REQUIRED BY LOS ANGELES COUNTY TE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 A THE LEGAL OWNER ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL P PERTYBACKFILL SEP
IC TAXKS f'.
LEEP PIT ! CESSPoO
SIGNATURE
rr
OF PERMITT I
WILLIAM J.FOX.C9dmTy ENGINE:m VALIDATION R A.WOOD.CHIYF FLBG INBPlCTOR
J&,8 2 1 '77 n JUL 13 4 4.5 0 In