HomeMy Public PortalAbout5655 SULTANA AVE_Sewer__ f7. 1`
'E8-08
6A6420 APPLICATION FOR PERMIT -
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND RARITY DIVISION BUILDING ;' /
JOHN A. LI4?e9BYE, County EngineerACDRESs ✓.�� # # '_
_
WILLIAM A. IIdSExI. $up'± of Building L:ldinTex
OCAL TY
NEARS T
CROSS 57 ;_
FOR APPLIFANT TO F I IN _
F _
-- - -- -
DESCRl P790N( I.,OT NO "'t OWN ER
Bf O!iKR,,CTP.UDRESS
SIZE Oc LOT NOW ON LOT CITY `.:� EX IND. � �,�.•� � �
JSE OF D15TRI ,T NO, GROUP MAP PROCESSED BY
BUtLCINGs
CONTRACTOR _ £ d a-
ADDRESS
CONNECTION DATA
� .f f_s.` Ey:_�' "'a�f � ��' — — —"-- -- - ---- --
r` #' STATION DEPTH
C 7Yr .c.
. TEL NO, l __
l
----------
STATE ---------
REGIS,RATION 110, MANHOLE REFERENCE
..Oti NTv LOWER
NO, DES
�
CRIPTION OF ',A70RK PEE TYPE OF CONNECTION LENGTH FROM
_ -__..___ _.
HOUSE 5 NER CON NECT;tvG TO CURB P.L. _M.L,TO.P.L.
PUBLIC SEWER @ $5.00 t "
-� 4EPTIC'TANK..SEEPAGE PITOR ---._. i.._--__ ____ P.C.NO.
CO. IMP.NO. JOB NO, 0
PITS
AN DC OR DRAiNFIELD @ $10.00
HOUSES VIER CONNE..7'ING TO '� TRUNK PERMIT NO. ROAD PERMIT NO,
PRIVATE DISPOSAL SYSTEM C $3:00 _
CNNECT i D -fi ONAI BLD.^, OR J + A.F FIDAVIT WAlBEk j EA5[nt[NT RECb Rp,iNS7R NO, DATE
v4ORK TO HOUSE SEN ER $3.00 I
OVERFLOW SEEPAGE PIT,DRA.INFIELD DON -
EXTN CESSPOOL.,DRYWFLL,MANHOLE @ $5.00
-. -s - ta - -HOUSE -- - -1 HWY.OR 5T.WiDWIDENING CL
']y eY+sT�ER.REPA '!TR-lB N
@ STATE
_ 53.:00 _.._._ ___—_ „y�p..
- — —._ ENCROACHMENT r”'
PERMIT No
INDUSTRIAL -
r
WA5TE APPROVAL .._
T._._ —._—_ — —
OWNERS PERMIT ---- -- - 2i p - _ ----- CHARGES
-- --- -` ---` z CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE -- - -------—-— ------------- — - ---- -
REIMBURSEMENT FEF_'
'I HAVE AT"PHIS DATE A CONTRACT, WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT T}.IE ABOVE. DESCRIBED EXISTING DWELLING --- - ----T- -- "-( --- ""
TO THE FURL C S '�/� R .�`�, -_ APPROVALS DATE I IN51`ECTOR�9 SIGNATURE
SIGNED T! IS DAY OF� _T
OWNER OR .' NEW HOUSE SEWER 1
�. t
OWNERS CONNECT ADDI?TONAL
BUILDING OR WORK
ADO 11 5 S_
i— -- - - SEPTIC TANK.SEP,PIT($)
I HEREBY ACKNOWLEDGE THAI I HAVE RE.AD THIS APPLICATION AND./OR GRAINFIELD
AND STATE THAT THE. ABOVE I:S CORRECT AND AGREE.TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
C (J?
PLUMBING AND SEWERS- E55POOL [I DRYWELL
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
1.1
CEN'i=_D AS RF(,IUIRED SY LOS ANGLES CO LINTY AND STATE OF S=WAGE DISPOSAL SYSTEM
AL!FOR NIA OR THAT 1 AM THE LEGAL. OWNER OF, AND INTEND TO !-- --- -------
DI CONNECT PLUG AND -
RESi 9E
IN. THE ABOVE DESCRIBp�p'? ESIT`ENT AL. PROPERTY. gBAN DON FO U.SE SFW FR
SIGNATURE dAC KFtLI aEF'71C TANKS � ❑i I-.--- __._.___-.__
Or PrRMITTFE, - --- - —_ ___----- SEEP.P1rIs> ❑ CESSPOOLS
VALIDATION ROBERT A, WOOD
SUPERVISING MECHANICAL ENGINEER
COC. M.O. CASH
9447 PAY 2S :1 0 D 5.00—
j
24650 INSERTS
E
76A6
` APPLICATION FOR PERMIT
.l,2A642D p
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING 3 - _m
BUILDING AND SAFETY DIVISION ADDRESS f' ,/
IOHN A. LAMBIE, County Engineer — -'
WILL%AM A. JENSEN, Sup't of Building LOCALITY
//'�qq r� NEAREST
F�{R A CNT. Q. >, CROSS ST.
ILI f Z:2 it
BLOCK TRACT ADDRiiSS. i , -- ,.- _`.- ✓?
SIZE OF LOT NOW ON LOT- - > ��v' uCITY �f g P ltt. NO.
USE OFBUILDINGS 4Y DISTRICT NO. GROUP BK MAP PROCESSED BY
_._ PG
CONTRACTOR
ADDRESS j )b, CONNECTION DATA
CITY TEL.NO STATION ',. �J ? DEPTH
r _
r' STATE MANHOLE#t6ERENCE r,' 1 'f UPPER•...
REGISTRATION N0.
COUNTY
/Z7 '°'�
NO. DESCRIPTION OF WORK
a HOUSE SEWER CONNECTING TO
�T�� PUBLIC SEWER @ PE OF ECTION LENGTH FROM t
SEPTIC TANK,SEEPAGE PIT OR 1. U B P.L. M.L.TO P.L.
PITS AND/OR DRAINPELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
•u0.IMP.NO. "`! ,` .a` JOB N0.
PRIVATE DISPOSAL SYSTEM $I.00 y.
W
CONNECT ADDITIONAL BLDG.OR ! - 'TRUNK PERMIT N0. . ROAD PERMIT N0, - R .� V
WORK TO HOUSE SEWER @ $1.00 _ _`�
' ALTER. REPAIR OR ABA14DON HOUSE STATE ENCROACHMENT F4
SEWER OR u SP_QSAL SYSTN! @ $1.00 PERMIT NO. O
'NDUSTP,IAL
WASTE APPROVAL
_ CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REI MBURSE MENTFEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED E4!STING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC. SEWlr, e,
SIGNED THIS /DA?F - °R 19 NEW HOUSE SEWER
OWNER OR F '•;. 7
OWNERS AGENT-"� .+�`- - --`� ,.��... �r CONNECT ADDITIONAL
_ _BUILDING OR WORK
ADDRESS _! / %"'. �.�_ SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DP,YWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEW£T2OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY. CERTIFY 'THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON ROUSE SEWER
OR THAT' I M THE LEGAL OW ER—OF THE AB VE - - -- —
DESCP.IBED RESIDENTIAk'PPERTY, I- _
`- 3ACKFILL SEPTIC TANKS Cl
SIGNATURE SEEP.PITS} El CESSPOOLS
OF PERMITTEE 'f' `� !-/ ��`': -'...
�F t VALIDATION ROBERT A. WOOD
CK. X.o. / CASH .:� SUPERVISING MECHANICAL ENGINEER
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