HomeMy Public PortalAbout5618 SULTANA AVE_Sewer__ °°^•••° ' APPLICATION FOR PERMIT
•••�•DIMSION OF BU=U?G AND SAFETY SEWER—SEWAGE DISPOSAL
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JOHN A LJAMBIE COUNTY ENameER -
m CASSATTD GRIFFIN SUI T OF OUIL°IN• LOCALITY
FOR ANT CRW9
LEGAL
DESCRIPTION LOT NO OWNER '
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BLOCK TRACT � 46�� , ADOBESS 'F is
912E OF LOT c:r 1 SLOGSNO JbF
NOW ON LOTCITY p.a.�[�i a.(., TEL NO Ja. 7 Jry
USE OF
BUILOIN GS • DISTRICT NO GROUP YAP `
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CONTRACTOR
ADDRESS Sf� CONNECTION DATA
CITY TEL NO Sb ', y'�C STATION DEPTH
MANHOLE REFERENCE - UPPER _
p f TATE LOWER
REGISTRATION NO ! ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH PACK'
PUBLIC SEWER @ 13 So Y CURB P L Y L TOP L
IEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q 3 00
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
EKTN CESSPOOL DRYWELL MANHOLE S 2 00 CO IMP mb, JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL lYSTEY ® S 1 00 TRUNK PERMIT NO ROAD PE T NO
CON NECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER S 1 00 o-O PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® S 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHA FEF
OWNER'S PmwT s I 00
AUTHORIZATION TOTAL PEE REIYBURSEYEX FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COW
APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABgVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER - NEW HOUSE SEWER
SIGNED THIS DAY OF 19—
OWNER OR _ BUILDING ORCT °W'ORKAL ' Q
OWNERS AG EKT 9EPTICTANK SEEP,PIT(S)
ADDRESS ANO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT,I HAVE READ THIS APPLICATION ,'CESSPOOLL•J DRYWELL❑
AND STATE THAT THSIABOVE 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 1 AN PROPERLY REGISTERED AND/OR S AND
PLUG LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT CT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVEHOUSE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE A/ SEEP PIT(S) ❑ CESSPOOLS❑
OF PERU ITTEE R
JOHN A LAMBIE COUNTYENGINEER Ay�DA'I'ION ROBERT A WOOD CHIEF PLEIG INSPECTOR
' 9804N AM31 4 3 U O o
DEPARTMENT OF COUNTY ENGAVEFM SEWER-SEWAGE DISPOSAL - 1
rbIVISION OF Bun.DING AND SAFETY PERMIT APPLICATION
5 COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER Ao0RE88 rj�l� �. Su\ 2V12 I
FOR AKp
TO RLL IN LDCALI
BUILDING 5lg11 I NEAREADDRESS 1. -{2V\� CROSS STLOOALI7Y T�/ v f DISTRICT NO SERIAL NO PERMITNO
NEAREST .-CRO888T . ECEIVED BY RuOy fw Impwtlon DATEISSUED
-OWNER OJ�`dA -.. _SADDRMAI LESS SI(j�J"p [ /{ UBE 20 OOCUPANCY BK MAPPB
CITY . LND. �Q,�.Z,S'� �- 3 CONTRACTOfl �J�t�._ Co,IMP N0.ADDRESS S(Ja"D' gfp�Q " ioe rG
CI / TSI _NO @Zj_F TRUNK PERMIT NO
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REGISTRATION N p 9'd,7 ❑ COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO STATET ENCROACHMENT_
PERMIBLOCK TRAn,&. Z tia�/ INDUSTRIAL
WASTE APPROVAL
812E OF LOT �X � OW OM LO �YCIf...L. CHARGES
USE OF
BUILDINGS CONNECTIOVVWORQE FEE
NO DESCRIPTION OF WORK FEE REIMSURSEMENTFEE
HOUSE SEWER CONNECTING 0
/ PUBLICBEWER 0) $ 858 RECEIPT NO IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLD R' EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXBTM NO DATE BY
SEWER OR DISPOSAL YBTEN 100
18CONNE T AND ABANDON SEWER
AMD/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR,
PITS AND OR GRAINFIELD 2.00 STATION -F1 DEPTN .�
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 0001 MANHHOOLEE REFERENCE
TYom
PE OF CONNECTION LENGTH FROM
Y ML TOPL
OWNERS PERMIT f I 00
AUTHORRATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THfi EUBLIO SEWER �[
SIGNED THIS DAY OF MEW HOUSEBEWER o S¢
1 CONNECT ADDITIONAL
ow 40 OWNER MP BUILDING OR WORK
ADBRE88-ry QQ _ AMD/OR GRAINFIELDEP Prc(B)
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLI- CESSPOOL Q DRYWELL 0
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 AND SEWERS SEWAGE DISPOSAL SYSTEM
A:D%OTR LIICERSED EBY IFY THAT I AS REQUIRED BY LOS EANGELES(STERED
COUNTY DISCONNECT PLUG AND
AND 8TAT8 OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSESEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BAOKFILL SEPTIC TANKS
SIGNATURE - SEEP PIT(8)o CEBBPOO191
OF PERMITTEE .[� 1C L.�l�[•��'1�,
TOA642A 603 7/55