HomeMy Public PortalAbout5668 SULTANA AVE_Sewer__ 7ZA0420
E-663 11.58 APPLICATION FOR PERMIT 1.
3&E-56
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A, LAMBIE, COUNTY ENGINEER -_hDDRf$S
j CASSATT O. GRIFFIN, SuP'r OF SUILE)PNG
LOCALITY
FOR APPLICANT TO F� NEAR sT,
LEGAL ----------- o�vi"+' -.-._ e -- -.. - ---- --
DESCRIPTION LOT.NO. 3 ,+" OWNER v�
MA IL
BLOCK TRACT -zy ,1 rjV ADDRESS �
NO. BLDGS,
SIZE CF LGT� I_ P1 O', ON LOT �.d"' , CITY ,,. :i-3-y�°✓'` -TEL. N0. '` jI
USE OF �;,�' DISTRICT GROUP MAP
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BUILDIN_S -- t- �'; r,.
SK PG
CONTRACTOR
ADDRESS �' CONNECTION' DATA
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STATION ,,, DEPTH _
..CITY �,y� / L, NO ____--st- ..-���--------/ UpP
Je�+�.r' MANHOLE REFERENCE y
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(] STATE `n►'+,,.a.
_ O
REGISTRAT[ N NO. C1 COUNTY --�
NO. ' DESCRIPTION OF WORK FEEV - - - --------- -
HOUSE SEWER CONNECTING TO - TYPE OF Q 4E
URS CT(ON LENGTH FROM
Y C .-:tet"" M.L. T'0 P.L. ,.
1 PUBLIC SEWER._. _ @ 3.S0 _S ---- ---
SEPTIC TANK SEEPAGE PIT OR
PIIS AND/OR DRAINFILLD __ r[ $3.00 I -------- -� -- -_.- -- _-_
1
OVERFLOW SEEPAGE PIT DRAINFIELD f--T. -- P C. NO.
EXTN ,CESS POOL,DR WELL,NANHOLE c $2.00 I CO. IMP N0. _ JOB NO.
ER 'G
HOUSE SEWCON INTO _� rc K
PRIVATE DISPOSAL.SYSEM $1.00 _ I TRUNK PERMIT NO � ROAD PERMIT NO.J' t ' �
CONNECT ADDITIONAL BLDG.OR 1��,— STATE ENCROACHMENT
WORK TO HOUSE SEWER 62 $1.00 I_. i— PERMIT NO.
- —----
ALTER, OR ABANDON HOUSE
SEWER
E i INDUSTRIAL
_SFW ER OR DISPOSAL SYSTEM - ---- L[� ^1.00 II( _ WASTE APPROVAL,
CHARGES
I
CONNECTION CHARGE FEE
OWNER'S PERMIT S 0 ------ ---------- -- ------
. -- - - REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE �
I HP.VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCON- APPROVALS I DATE ,INSPEC'1'0R.SSIGNACURE
TRACTOR TO CONNECT TI4.E ABOVE DESCRIBED EXISTING DWELLING.TO YbE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 - - I - --v-�- -
,. CONNECT ADDITIONAL
OWNER OR ;+' .. BUILDING OR WORK
OWNERS Arc �r --
PTIC TANK,SEEP,PITS)
ADDRESS - -. - C - - ND/OR DRAINF.IELD I,
DRY
THIS APPLI ATION CESSPOOLLl
I HEREBY ACKNOWLEDGE THAT I HAVE READ I.=J IVELL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _- -----
WITH
_WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR I I
P,UMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
3 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR D ----.. -- –
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i AM THE LEGAL„O,1V-N F..ft OF THE ABOVE ABANDON 14CUSE SEWER- --- --- - —+--------� -- ---� -
DESCRIBED RE5iDENT3A,kFRUPER7Y BACKFILL SEPTIC TANKSC� 1- - - -
SIGNATURE" d�' ��• .-= y
OF PERMITTEE s .> SEEP.Pi'r(S i (_. CESSPOOLS❑
1w Ir
IOHN A. LAMBIE, COUNTY, NGINEER VALIDATIOJ� ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
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