HomeMy Public PortalAbout5525 SULTANA AVE_Sewer__ 76AS4 lop APPLICATION FOR PERMIT
C ESOS 1 -S
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTNI:INT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION eu ILDING
OFDi A LAMBiE Com1y EDqq�[ooEBr ADOREee v�LS—a. � /✓q
A. JENBEN, Sup 1 of OuBdmv
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FOR AllyqA4T TO ♦1YL Ll\ CROCp pT
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rRKGI�RATIOM
ION LOT NO OWNER
MAIL q
TRACT `I AODRLpS }Q OD �y[
NO OR SEGOS
LO NOW ON LOT CITY [ •TEL NO 1
�[ C D18T11CT NO GROUP MAR RROC[BBCD SY
I[ CBK PO
TO ��_SFAJ LL � CONNECTION Dr[L Nof pTArlonuRP{R
OX NO IF STATE MANHOLE REFERENCE 1 .
NO DESCRIPTION OF WaRIK FEE TYPEO R ION, LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L
PUBLIC SEWER Q i0 00 d
SEPTIC TANK SEEPAGE PIT OR PC NO 0
PITSANO/ORDRAINFICLO 0 11000 CO IMP NO ' (/ JO{NO V
HODS[BEW{R CONNECTING TO TRUNK PCRYIT MO ROAD PERMIT NO GC
PRIVATE DISPOSAL SYSTEM C 82W 0
CONNECT ADDITIONAL BLDGORUAFFIDAVITIT LYr[[ [.V[R[Nl RECORD INSTR NO OAT{
WORK TO HOUSE SEWER • iS 0
OVERFLOW SEEPAGE PIT GRAINFIELD d
[TTN CESSPOOL DRYWELL MANHOLE O 85M
A AN OURST WIDENINGZMPSII DISPOSALSYSTEM Y •S ONCROACXMBnT
NO
RIAL
PPROVALCHARGES
OWNER'S PERMIT AUTHORIZATION TOTAL FEETION CHARGE F[{
I
HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT F[[
TRACTOR TO CONNECT THE ABOVE DESCRIBED [TISTINO DWCLWHO A✓<lROVAI�
TO THE PUBLIC SEWER DAT[ INSPECTOR SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OW NERO AGEXT
CONNECTADDITIONAL
AOOR[86 BUILDING OR WORK
SEPTICTANK SEEP PITS)
I HERESY ACKNOWLEDGE THAT I NAV[-READ TH I{ APPLICATION ONO/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AOR RE
TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CK"PooL ❑ ORYWELL ❑
1 HERESY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER REPAIR SEWER OR
LICENSED AS RIO IRED BY LOS ANGLES COU TY AND STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA 1 AM THC [GAL OWN OF A IHT{MD TO DISCONNECT PLUG AMD
RLBIOE IN TH D[SCR D REBID[ RFY ABANDON HOUSE SEWER
SIONAT �.(/,�� BACKFILL SEPTIC TANKS ❑
a:EP PITS) ❑ CESSPOOL,
VALIDATION ROBERT A WOOD
cT/J Y o CASH SUPERVISING MECHANICAL ENGINEER
UC05 4 7 6Z& NOV 2 1 0 D 5,00^' IS
. L,
CEBOS10-63
TBA64zD APPLICATION FOR PERMIT
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COF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENTTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BwLDGG
WMAT°MRIP Go I, }yq�D°p ADORE �V ��
.YVI�1J_'.IA`l-R- A nMEN Sup 1 Of Di ddmQ
LOCALITY
nEAR[er
VRA
OR APPUC O CROSS-ST
PTION LOT NO OWNER
MAIL
TRACT ADDRESS
/ O OF BL 8
F LOT O NOW ON LOT CITY TEL NO
°S DIQTRICT NO GROUP MAP PROCESSED tY
�1 �CTOR C . A. DEVISE Sewer Contractor J/�Q y � ���S 1]20 W. 139th St. CONNECTION DATAar ena TCL NO FA 19 STATION � —L DEPTH t
Lu.5 TATEATION NO ® COUNTYMANHOLE REFERENCE / UPPERDESCRIPTION OF WORK Pte TYPE of CTION L[naiH FRoOUSE SEWER CONNECTING TO ISTATE
CU p P L M L TO P L ELIC ECW' ,EPTIC TANK SEEPAGE PIT OR P C NO O
IT°AND/OR DRAINFIELD C EIOODP NO UOt NO VOUSE SEWER CONNECTING TO PERMIT NO ROAD PERMIT RO RIVATE DISPOSAL SYSTEM 8 f!OO O
CONNECT ADDITIONAL:LOO OR VIT mp .V .... RECORD INSTR NO DATE 0
WORK TO HOUSE S[Wtfl Q f!Op
OVERFLOW SEEPAGE PIT GRAINFIELD
L%TN CESSPOOL DRYWELL MANHOLE 0 I°DOR ST WIDENING Z
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPO:AL SYSTEM B 33WLXC ROACNMENT NORIAL APPROVALCHARGE[OWNER'S PERFDT s xAUTHORIZATION TOTAL FEE CTS ON CNARGC PCL1HAVEATTHISDAT[ ACONTRACT WITH THE HEREIN NAMED CONN REIMSUMIMENT M%
HAVE TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_ ��
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BWLOI NO OR WORK
LAS"DON
ANK ELLP PITIB)
I N[ftEQY ACKXOWLC°GE THAT 1 HAVE RCAO THS: APPLIGTION GRAINFIELD
AnD STATE THAT THE ASOV[ 1: CORRECT AND AGREE TD COMPLY
WITH ALL COUNTY ORDINANCE° AND STATE LAWS REGULATING.
PLUMBING AND ECWERG L ❑ DRYWELL ❑
1 HEREBY
CERTIFY THAT I AM PROPERLY REGISTERED AND/OREPAIR SEWER OR
LICENSED AE RCOVIRED BY LOS AHOL[A C ETATB OF DISPOSAL SYSTEM
CAL IIORnIA OR THAT THE LEGAL OW�DF I ND TDECT PLUG AND
R[HIDC IN THE V [QC N HOUSE HEWER
REL SEPTIC TANK°T IS) ❑ CESSPOOL[
ALROBERT A WOOD
M 0 C
CK M o AQH SUPERVISING MECHANICAL ENGINEER
L o6404ZZ DEC 2 1 O D 7.00-