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HomeMy Public PortalAbout5564 SULTANA AVE_Sewer__ G68086SA 6620 65 APPLICATION FOR PERMIT cNT OF LOU ANGELES - SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /�5_/L/ JOHN A LAIIBIF Couvty Fvgm,, ADDRESS 16 M _7 COT F VAN % JF\AI\S Sup t of Buildmq LOCALITY (, , NEwR[9T FOR APPLICANT TO ML IN E `'� OE➢LaAL CRIPTION LOT NO OWNER / MAIL BLOCK TRACT ADDRESS NO OF SLOGS 2 Q A SIZE OF LOT NOW ON LOT CITU TEL NO bI a USE OF BUILDINGS DISTRICTNO GROUP MAP rROCfY6lO BY _ BK RO CONTRACTOR Y.DR0A//CS waDREee �//�^ '/ ,�/� Mz CONNECTION DATA CITY 01b111 W" T[L NO 2 �a a STATION DEPTH LICENSE Oa e � CILCAES SBE n ,/— '56 MANHOLE REFERENCE LOWER LI ` 7 NO DESCRIPTION OF WORK FE! TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL ML TOP PUBLIC SEWER B $ 9 OB �. L PC NO d PITS ANO/OR GRAINFIELD 6 $10 00 CO IMP NO JD6 NO /\ HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO :VS PRIVATE DISPOSAL SYSTEM C f 3 00 CONNEADCT T GL BLOO OR ,Y , AFFIDAVIT WAY I. 4i[II[xi RECORD IX9TR NO DAT[ O wOR TO E ER (+ f 3 00 B WER OIB PORAL SYSTEM ([ $ 3 00 HNY ORST WIDENING d E%TN CESSPOOL MANHOLE C $ 6 00H BENCROACHMENT Z PER CO LIT N TELT P { 9 OO PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S I PERMIT S 2 00 CONNECTtOH CHARGE FEE AUTHORIZATION TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC [EWER DATE INSPECTOR 5SIGNATURE SIGNED THIS DAY OF IB_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL AOOR[68 BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AN./OR TANK SEEP PIT(B) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 'YND/OR DRAINFIELO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY l06 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM re CALIFORNIA THAT AM THE LEGAL OWNER OF AND I NO TO M ESIDE IN ABOVE DESCRIBED RES [ I Y DISCONNECT PLUG AND ABANDON HOVSf SEWER BIanAT e OF P BACKFILL SEPTIC TANKS ❑ 9[EF rrclm ❑ CESEPOOLG VALIDATION CK M O CASH 615479217AM31 io D 8L0- I ^I DEPARTS ENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DMSION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENOIN[CR BUILDING r ADORE88 J FOR NAPPLICANT �JTO FILL IN LOCALITY B E Lo' J j' ��- w NEAREST GROKB BT L4 4 n he a lnet CALITY DISTRICT NO SERIAL NO PERMIT NO AREST A L 1401 S MS ST BJI/ NER RECEIVE BY RndY I"Imp"U" DATEISSUED L.ai�/ W 3- 7-53 " �OREBBUSEZONE• OCOUPAMCY BK YAPPB Y TEL NO 6? CS CONTRACTO CO.IMP NO ADDRESS JOB NO CITY TEL NOj b,?/;p44 /�8 ATE TRUNK PERMIT NO REGISTRATIO O MCOUNTY ROAD PERMIT NO DESCRIPTION LOT NO �T �1.�m �/� PERMIT NCCROACHMENT l� BLOCK TRACT � � 7/Y./A.fI• INDUSTRIAL BF BLD88 WASTE APPROVAL SIZE OF LOT I a) �7 .y� (VON LOT CHARGES USE OF B /v 8UILOING6 CONNECTION CHARGE FEE NO DEBCRIPTION OF W K FEE HOUSE SEWER CONNECTING REIMBURSEMENT FEE PUBLIC SEWER @ i Seo .f© RECEIPT NO DATE -Foy Y H0USECEWER 00NNE6 INO TO PRIVATE DISPOSAL SYSTEM I DO "y CONNECT ADDITIONAL BLDS OR _ EXCEPTION RECORDED WORK TO HOUSE SEWER 100 ALTER OR REPAIR EXISTING NO DATE BY SEWER OR DISPOSAL SYSTEM IMI ISCONNECT AND ABANDON SEWER AND OR DISPOSAL SYSTEM 100 CONNECTION DATA ' SEPTIC TANK,SEEPAGEPIT OR PITS AND/OR GRAINFIELD 2.00 CESSPOOL—DFIYWELL STATION .)1. DEPTH SPECIAL CONDITIONS ONLY 200 3 SOS NUPPELE R REFERENCE ' TYPE OF CONNE ON LENGTH FROM OWNERS PERMIT $ t 00 CURB ML TO P L AUTHORIZATION I TOTAL FEE SC 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOWB SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS DAY OF . ,,/ IA� S NEW HOUSE SEWER OWNER OR - „^.�y_ ___ CONY EOT ADDITIONAL OWNERS ADEN BUILOINB OR WORK ADDRESS a7 ' BEPTICTANK BEEP PIT(8) AMD OI DIUINFI ELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A LI• CESSPOOL[] DRYWELL� CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLUMBING AMD KEW ERB SEWAGE DISPOSAL SYSTEM AN OR LICENSED CERTIFY IA8 REQUIRED BY T I AN PLOD ANGELLY ES COUNTY DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN. ABANDON HOUSE 8EWEIf ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY -TACKFILL SEPTIC TANKS SIGNATURE og ` BEEP PIT(S)C] CESSPOO OF PERMITTE T6Aft2D 80E 1/08 a