HomeMy Public PortalAbout5660 SULTANA AVE_Sewer__ 76AE-ced 5:•5S APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING J'
JOHN A. L_AMBIE, COUNTY ENGINEER ADURrss�r ✓�� � ��� r �:- ,�`� —�
13 CASSATT 0. GRIFFIN,SIJt'T of BUILDING "✓
LOCALITYNEAREST
•,✓'.r .��:,._ � -rt'�.-.<<,;
FOR APPLICANT TO PILI. IN CROSS ST
LEGAL OWNER
DESCRIPTION LOT NO. - -- ---- _ --�� -- �, �• i..,.,..,. �;
------- -- h5AIL
BLOCK TRACT TRACT'-._ _KID _E5- S -7
NO.OF BLrGS -- CITY TEL.NO.
SIZE_OF LOT NOW ON LOT, r
gUELOFN.LS ;c_ - DISTRICT N0. I GROUF- MAP
EK PCS
CONTRACTOR .tib e - � �_ �. --, •� ---- --
X"
r CONNECTION DATA
ADDRESS � ------------�--------
_. .
STATION DEPTH
CITY f' TELNO. <: .g*i _
. MANHOLE REFERENCE _- UPP_ER
L7 STATEL P'ER
REGISTRATION NO, '��' � N ❑ COUNTY ----- `---- ^_—_'-•-- -.____.,...-_�_-.:---_—_---
N0. j DESCRIPTION OF WORK FEE -� TYPE OF CONNECTION– LENGTH FROM --�--
-, HOUSE SEWER CCNN CTING TO - �.----^ I y CURB P,L. M.L.TOP L
PUBLIC SEWER r $3.50 ..__.--.. —�_----
j SEPTIC TANKS SEEPAGE PIT OR
PITS AND/OR DPAINFIELD CI. $3.00.
--- - --- r -- I --- P. C. N0,
W OJ kF LO SEEPAGE PI S'DRAINELT,
EXi CFS POu^L,DR 4\Li_!„\ Nn E f $2.0G CO. imp. NO, JOB NO.
HOUSE SEWER CONNECTING TO � I
PRIVATE;DISPOSAL SYS EM $?.00. ; TRUNK PERMIT N0, ROAD PERMIT NO. -
.71 L LUORONNEC ADDSTATE ENCROACHMENT
..moi WORK TO FUSE S�)NER II• $1,00 '✓ tERR1IT N0. _
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER.OR DISPOSAL SYSTEM «t- s 1.00 _ WASTEAPPROVAL
_ CHARGES
C^i4"aEC ION CHARGE FEE -
CJ` NERISPERMIT i OO -- -- --
AUTHORIZATION TOTAL FEE - R iMRURSEI ENr FEE
-- �__ . -� APPROVALSI
D ATE `1"isF'EC'1 RSGIGNAT URF'
[ HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- -,-_— —----_. ___-. ---�--�
TRACTOR TCI CONNECT THE ABCDVE DESCRIBED- EXISTING AWELLING �
THE PUBLIC SEWER. NEW HOUSE SEWER 1
SIGNED TFs'IS_ DAY �F_— —.X� CONNECT ADDITIONAL. I j
B..UI_LDINf OR WC
CR_.Kx C?R .. --- --'--. ----- ---
OJNLhA( - '------
-- -- 5EPFI TANK,SEEP,PIT1,S.}
_A.U!;RES 1Lj i° t �' :.� ✓ AND/OR DP.A'N Ic LD-- - --._..._--� ---------`-----
i hFpC r:Cr LEDC E TN- i r I „4E RFA.p THIS �r'PLICA''ION f
CESSPOOL IJ DRYV'ELL
E ABOVE f5 CORRECT AND AGREE TO COMPLY
-vITH ALL C)UN ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR J
I'LU.k.. NC AND SR.WERS. SEW'ACE DISPOSAL SYS'iEM I I
F E 4L3'� C!RT t7 THAT I AU PROPERLY REGISTERED AND/OR DISCONNECT PLllG AND -_
LICENSED AS RF UIIPEC BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER JI.
LiFORN' OR HAT A-V LEGAL _.WNER OF THE ABOVE ---- --- ---- ---- - --- --,
D SCRIE-ED P.E S i NENTIA }+^,t'i P F Q TY. a A.C K LP7 1 LTANKS rj
. Si(;..N AT URL" .�,.+"r SEEP_PIT 5, SKS:PO n I_.. _...____.
OF PLRM;T TEF, -_i._-._..---..
;OHN A. LAMBIE, COUP4''Y ENCiNEEItVALII3ATION ROBERT A. `,M1 00D, CHIEF PL.BG. iNSRECTOR
cEfloa
16AG42D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. YENSEN, Sup't of tuilding
LOCALiT
14 R F s-
FOR APPLICANT TO FILL IN CROSS ST,
LOT NO
JI. f. 1 5 4 OWNER A-
MAIL
BLOCK TRACT ADDRESS_�5 X 'y css
T
__V
_7
O_.'. -D'
-517"E 01 LOT TEL, NO,�'
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESUED BY
SK PG
CONrRACTOR
ADDRESS CONNECTION DATA
ST AT`t - LIEF.H
❑ STATE UPPER
REGISTRATION NO. LOWER
_OUI,,T,y MANHOLE REFERENCE
NO. DFSCRIPTION
OF WORK FEE TYPE OF CON,NEC-T ION LENGTH FROM
Y, _ CURB P.L. MAL.TO P.L,
PUBLIC SEWER L
sr�.00 - I — _ ___-- - -------- ---—_-__
---
I SEFTiCIANK-,SEE PAGE-PfT' OR
1 PITS ANG/CSR NL.
R DRAIF!10CO.IMP. NO. JOB NO.
HO-ISF SEWER CONNECTING TO TRUNK PERMIT Na. ROAD PERM-IT NO. 0
PR!VATE S
_01SI"OSAL SY TEM @ s3.00
"ON OR
, NEC-, ADDITiONA'-BLDG AFFIDAVIT I WAIVER 1 EASf%g.NT T RECORD,INSTIR.NO. I DATE
WORK'1 0 HOUSE.SEWER @ $8100 LU
-PT1 a-
OV�RFL-OW SEE�PAGE
rXTN�.C:ESSPOOL,DRYWEl-L,MAfqH.OLE @ $5.00
HOUSE— HWY.OP.ST.WIDENING
I SEWER STEM @ $3.00
STATE.FNIROACHMENT
PERMIT NG.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEIRS PERMIT
- 00 CONNECTION Cf;ARGE FEE
AUTHORIZATIONITOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
D
TNACYOR T CONNECT THE ABOVE OFSCR. !BED EXISTING DWELLING
DATE Io
'�O THE PUPR
BLIC 5EWZR. APPROVALS NSFll-T
SIGNED THIS DAY Or 19
OWNER OR
-7 NEW HOUSE SEWER
OWNERS AGV'0f /tie
CONNECT ADDITIONAL
BUILDING OR WORK
TANK.SCEP.Rl
I HEREBY A N. WLEDGE HAVE READ IH15 APPLt GAf
ANDSTATE T 'T THE ABOVE IS CORRECT AND AGkEO COMF 'TF'-LY 'AND!OR DRAINt
- -----
WITH ALL. .-X)UNTY ORDiNANCFS AND STATE". LAWS REGULATING
PLUMBING AND :EWERS, OR VINE .L,.0
I HEREBY CERTIFY THAT PROPERLle G
REISTERED AND/OR ALTER,
REPAIR,SrWEFZOR
LlC I AM
ENSED AS R"QUIREV By THE LOG ANGLES COUNTY AND STATE OF SEWA E DISPOSAL.S'�TEM
CALIFORNIAOR THAT 1 AM AL OWNER O , ANINTEND TO
RESIDE 5 LF G RESIDENTIAL
FDE*IN, THE ABOVE DE5CRi FD IAL PROFRTY. PLUG AN
ABANDON HO USFSEWED
R
BACKFILT SEs TANKS El
&V PrRMI;Fl*E,ll� '�,_"�-'- -m Ell
VAUDATION ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
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