HomeMy Public PortalAbout5626 SULTANA AVE_Sewer__ B&M APPLICATION FOR PERMIT 7
BUMDING AND SA= SEWER—SEWAGE DISPOSAL 1
Of cGBBty eB,rmD.! 2G
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Of Los Aae a BUILDING
BIE COUNTY ENGINEER ADDRESS
CID D GRIFFIN SUPTOFBUILDINO LOCALITY
FOR APPLICANT TO FILL IN CROSSST temp
LEGAL
DESCRIPTION LOT NO OWNER
'UAIL
BLOCK TRACT AODpEb e
NO SIZE OF LOT
NOW
OON LOTSffA�T
Y TEL 1
USE OF DISTRICT NO GROUP 1 YAP
USEBUIOFNGb
BK PG
CONTRACTOR
ADDRESS s J' COD CTION DATA
CITY TEL NO STA TION DEPTH
R OLE REFERENCE UPPER
REGISTRATION NO No DESCRIPTION OF WORK FEEHOUSESEWER CONNECTING TO TY E OF CONNECTION LENGTH FROM
PUBLIC SEWER @ S 3 SO CURB P L M L TO P L
SEPTIC TANK SEEPAGE PIT OR PITS AND/OR GRAINFIELD ® S S 00
OVERAINFIELD
EZ NF CESSPOOL,ORYWELLLOW SEEPAGE PIT RMANHOLE ® S 2 00 IMP NO I3 .7 y POB NOHOUSE SEWER CONNECTING TO
RIVATE DISPOSAL SYSTEM ® S1 00UNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 1 00 PERU IT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL '
SEWER OR DISPOSAL SYSTEM $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S Pmtmff s 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
APPROVALS GATE INSPECTOR SSI URE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON '
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER ,NEW HOUSE SEWER 1
SIGNED THISAYOF 19_ CONNECT ADDITIONAL
OWNER AGE T r� /� BUILDING K,WORK
OWNERS AGENT ivJili SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
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 SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEP IC TANKS❑
SIGNATURE SEEP PIT(S) CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE, COUNTY ENGINEER ALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR,
4c5 M o CA
6 16t APR 29 4 A 450 a