HomeMy Public PortalAbout5600-5602 SULTANA AVE_Sewer__ Bee sea hell APPLICATION FOR PERMIT 1
DIVISION OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL
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Comfy of Las AagalMs BODRESS
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CASSATT D GRIFFIN SUP T OR BUILDING 'LOCALITY
FOR APPLICANT TO FILL IN epOSS eT
LEGAL
D CRIPTIOR LOT NO 60T OWNER
BLOCK , TRACT 9 ADDMAIL RESS
SIZE OF LOT NOW ON LOTS CITY TEL NO
USE DI
BUILDINGS DISTRICT NO BROUp YAP
(r BK PO
CONTRACTOR
ADDRESS �C' If �� STATION J JC�O6,RNECTION DATA/OL
CITY S G. TEL NO �r DEPTH '
MANHOLE REFERENCE 3 '; j UPPER
REGISTRATION NO _/ ❑ STATE .
r ❑ COUNTYly
140 DESCRIPTION OF WOZ FEE
HOUSE SEWER CONNECTING TO TYPE OP ION LENGTH FRGl
PUBLIC SEWER Q S S SO Y CUR P L 4 L TO P LOU O,
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IVP NO /3 7 2. JOB NNo
O
EZTN ,CESSPOOL,DRYWELL MANHOLE $1 00
PR HOUSE SEWER
PATE DISPOSAL SYSTEM6 TO ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO q42 /`7
CON N ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $I Do PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q 100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE ,.
OWNERS PE82AT i 1 00
AUTHORIZATION TOTAL M D REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS _ DATE INSPE OR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EK IST G DWELLING I
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED TH,tSAY OF 1 CONNECT ADDITIONAL
OWNER n BUILDING OR WORK
OWNERS A SEPTICTANK SEEP,PIT(S)
AOOpE9ILZ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ORYWELL❑
ANO 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
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA THAT I AY THE LEGAL OWNER OF THE ABOVE
DESCALMD R IDENTIAL PROPERTYI / RACXFILL SEPTIC TANKS
SIGNAT SEEP PIT(S) El CESSPOOLS❑
Y ,
OF P Y E
Rob
JOHN A LAMBIE CdUNTY ENGINEER JF VALIDATIO ROBERT A WOOD,CHIEF PLBG INSPECTOR
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