HomeMy Public PortalAbout5608 SULTANA AVE_Sewer__ aamGsItas APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
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COMnty of Los Angeles BUILDING /�
JOHN A LAMBIE COUNTY ENGINEER AooRH$s t (G
m CASSATT O GRIFFIN SUP T OP BUILDINO LOCALITY P G.
FOR APPLICANT TO FILL IN c OSS ST
LEGALOWNER
DESCRIPTION LOT 0
BLOCK TRACTS MAIL
ADDRESS
SIZE OF LVIF V 7 tO OF BLD
OW ON LOGS / CITY TEL NO
BSE F
DI DISTRICT NO GROUP YAP
BUIL
BK PO
CONTRACTOR
CONNECTION DATA
ADDRESS
STATION DEPTH
CITY 5 S� G TEL NO 45Lrlo
MANHOLE REFERENCE
El STATE
REGISTRATION NO
✓7 9 L ❑ COUNTY I - LOWER
NO DESCRIPTION OF WORK FEE ,
HOUSE SEWER CONNECTING TOPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 SO Y CURB P L Y L TO P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAIRFI ELD ® S 9 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE 0 $2 00 CO IMF NO JOB NO
HOUSE SEWER CONNECTING TO 90��7
PRIVATE DISPOSAL SYSTEM ® $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (a $I 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERM s00
AUTHORIZATION TOTAL, PEE tlm
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNA URE _
TRACTOR TO CONNECT THE ABOVE DESCRIS D EXISTING WELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS AT 1 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANX,SEEP PIT(S)
ADDRESS ANO/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AMU/OR DISCONNECT PLUG AND
ICENSE AS REO UIRED OS ANGELES COUNTY AND STATE OF
CALLED AS OI TXAT I Ml THE LEGALAL W HE ABOVE ABANDON NOOSE SEWER
ESC ED RESIDENTIAL 0 E TY BACKFILL BEP7T1C TANKS❑
SEEP PIT($) ❑ CESSPOOLS❑
O PE0. EE
JOHN A tIAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLJBG INSPECTOR
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