HomeMy Public PortalAbout5660 1/2 SULTANA AVE_Sewer__ IDEPAW ENT OF COUNTY ENGINEER SEWER_--SEWAGE DISPOSAL
DNISION OF BUILDING AND SAFETY MIT APPLICATION
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COUNTY OF LOS ANGELES •^ r ;'
WILLIAM J. FOX. COUNTY ENDINEERBUILDING f• /�' f ,; a.
;7 I ADDRESS C�/l). `�Ct ec� -. •J a,l'�' •..i f w lK7
FOR APPLICANT TO FILL IN- LOCALITY
BUILDING �e EI p NEAREST '
ADDRESS d �lJi �yrr3 (e CROSS ST.
LOCALITY G�� DISTRICT NO. - SERIAL NO. PERMIT/NO.
NEAREST �`a— .e�.i .5 A J'/ .4 S
CROSS ST. s +i' ' 1./
�� �RECEIVED BY Ready for Inspection DATE ISSUED
OWNER O't+MAIL
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ADDRESS USE ZONE /OCCUPANCY BK-M/1 Q
a,t /Z7 VLQ�1 1 I �E
CONTRACTOR _ CO.IMP.NO. �r
ADDRESS ; �= JOB NO. -- --_--_
CITY TEL.NO. �„ � TRUNK PERMIT N0.
REGISTRATION NO. re�C) U COUNTY
ROAD PERMIT NO. / 7/3
! /
DESCRIPTION LOT NO. STATE ENCROACHMENT
_______
PERMIT N0. '•
BLOCK, // TRACT r, _.�o�,r- �Y'. INDUS APPROVAL
812E OFL0T1/,2X X.L� NO;N9oFMTS. WAST ` CHARGES
USE OF
BUILDINGS ` CONNECTI'ONCHARG`FEE
NO. DESCRIPTION OF 'WORK_ FEE
OUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER 0$ $ 3.50 A Uri 1 RECEIPT NO. D_ TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 I
-CONNECT ADDITIONAL BLDG.OR /� EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 Q o 6
ALTER OR REPAIR EXISTING NO. DATENI BY
SEWER OR DISPOSAL SYSTEM 1.00 /
DISCONNECT AND ABANDON SEWER .
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION /..g f i' DEPTH �J
CESSPOOL—DRYWELL , _
SPECIAL CONDITIONS ONLY 2.00 / f MANHOLE REFERENCE
UPPER '-LOWER:-..
TYPE OF CONNECTION LENGTH FROM /
�Y--- CURB �P.-I.. M.L.TO'P.L.
OWNERS PERMIT $ 00 �
AUTHORIZATION I TOTAL FEE A I,-5A
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVEDESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO T*PLIC SEWERSIGNED THIS.... Y OF..._ L� ._�_i NEW HOUSE SEWEROWNER OR CONNECT ADDITIONAL
OWNERS AGEN _. ..�... -..........._ SEPTBUILDING OR WORK
ADDRESS.....q.W ..fE :.� �/ QL LCL:. AND%OR DRAINF ELEEP.D PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND LICENSED AS REQUIRED BY l08 ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR'THAT,I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE -` SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE......`:_=.:_....�}.� _y� .
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