HomeMy Public PortalAbout5671 SULTANA AVE_Sewer__ ' &F-663 12.54 A6
5 21: PP�LICATIOIlI.. FOR PERMIT
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DIVISION OF BUILDING AND SAFETY DISPOSAL
Deportment of County Enginear
County of Los Angeles DUILnINc
WM.J. FOX, COUNTY (ENGINEER ADDRESS,
CASSATT D. GRIFFIN, SUPT OF BUILDINGLOCALITY
— 1:
.. NEAREST ! ,,
FOR APPLICANT TO FILL IN cRoss sT
LEGAL 7i
D£SCRIPTI N OWNER
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BLOCK 1RAC1. �. - ;. '..; MAIL
i
NO.OF BLDGS.
SIZE OF L T. -�',. NOW ON LOT
—ADDRESS
TEL.NO,:l
DISTRICT No. GROUP I MAP
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$K PG
CONTRACTOR A, Y
YADDRESS yp i�' c" �+ �- -- ,,•p.� CONNECTION DATA �_..._.._._.._
CITY TEL. NO.I—t- 4. /"Cr{ �i STATION :7$ '�Y' �. 5 b DEPTH .
STATE 'z - r`r MANHOLE; REFERENCE
REGISTRATION NO, a.. a'x' y� t� COUNTY ` `�` Ii^iie..r- LOWER,
"- '---- — TYPE OE-€-GUNECTION LENGTH FROM `� r
NO. I DESCRIPTION OF WORK FEE % ;�UI1 � P.L. M.L_TO P.L.
I HOUSE SEWER CONNECTING TO I -�; r
_P U e L I C SEWER
ER _ Y' (a) $—" 50_I ) E:3(..✓ -- - --- y, ,p------ -
�� HOU e SEWER CONNECTING TO
-PRIVATE DISPOSAL SYSTEM _ 1.00 i CO
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CONNECT ADD.TION`; AL BLDG. OR �
i •t" I.., . � Job. N0.
WORK TO HOUSE SEWER L00 IMP. N0.i �,
ALTER.OR REPAIR EXISTING i.
S.ES4£R OR DISPOSAL L SYS tEM 1.00 j TRUNK PERMIT NO. ROAD PERMIT NO. ;.'.� y '.
DISCONNECT ANDAb A^IDON SEWER STATEENCROACHMENT -
AUIR U
O1SFQaA1 S Sf£_M —_1.00 �_ _ at RM,IT h0.
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SEPTIC
TA NY SEEPA F PlT OR
PITS AN lOi DRA NFIELD 2.00 :Ill DU Tx ISL
CESSPOOL- DR=WELL -. j I" WASTE APPROVAL
�I SPECIAL CONDITIONS ONLY CHARGES
CGNNECTION CHARGE FEE
O' TER'S — PERMIT S 1 � 00 -- --.
AUTHORIZATION 11 TOTAL EEE — j REiRBUPSE'4ENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- pie �c
TRACTOR TO CONNECT THE ABJVE DESCRIBED EYISTING DWELLING APPROYrALS DATE INSPECTOR'S SI 'NP.T'URc
TO THE PUBLIC SEWER ---
_.' NEW HOUSE SEWER
SIGNED THIS T),AY OF
OWNER OR ;' `CONNECT ADD OVAL '
OWNERS ADEN _ is S BUILDING OR WORK .
rs, '. .E-:-its.. ` -�A 'A' � ,r r x BUILDING
TANK, SEEP, PIT(S)�
ADDRE-S.-------r _ 1 :� !/ - ... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CORIPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEYv'ERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR �-LICENSED AS AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR TPA;' I AM THE LEGAL OWNER CF THE ABOVE __-A_BANJ_O_N_HOUSE_SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS D -- - -_
�,.
SEE P. PiT(S) El CESSPOOLS 0
SIGNATURE
OF PERMITTEE �„�: ..,„.p„ i
;..,r --
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY
AY' BY xa _rs rr>
r; n-.t Pnry