HomeMy Public PortalAbout5677 SULTANA AVE_Sewer__ S&E-663 62.-54 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer `
County of Los Angeles 'BUILDING+
WM.J. FOX. COUNTY ENGINEER
CASSATT D.GRIFFIN',.SUPT OF BUILDING LOCALITY 1
FOR APPLICANT TO FILL IN NEAREST
t'.ROSS ST ,-
y ._ _.
LEGAL
DESCRlPT10 LOT NO, C^-,�.�- )',VNER
BLOCK I TRACT _ • MAIL
AA(iRESS
'NO. OF BLDGS ..
.SIZE OF LOTS - NUYV ON OT -C,7Y :i TEL, NO.
LOT
USE OF
_BUILDINGS �_ ._` ys- DISTRICT NO, i G!@OOP, BK MAP PG
CONTRACTOR ,. --
ADDRESS CONNECTION DATA
61
CITY � s., ¢�.,. TEL, NO.Z. r�` < e'd STATION, � "".+- DEPTH
STATE
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STATE r -�' `I MANHOLE REFERENCE •'�
REGISTRATION NO. j e �' s-/'{� C, COUNTY _, _- — f3f -> LOWER
i - ----r------ TYPE t�F Cmm iE.CTIONLENGTH.FROM ""•` •.
No. i DESCRIPTION OF WORK FEE —Y. --_ URB �1- P..L.,,�— M L TQ P_Lw_ ,,.5 ,.
HOUSWLR C NN CTIN G TO - -�
PUBL IL EWER 3.50
!
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM _ 1.00
T AODIFIONAL LDGOR
B .
WORK TO HOUSE SEWER __ _ i,4.4 ! If CO, IMP. NO, JOB. NO.
CONNEC
ALTER OR kEP.AtR Lki5T'IPIG^ -
SEWER PERMIT
q y
TRUNK PF12MIT NO. ROAD NO
OR DI5P O',AL SYSTEM _ 1.D0_i -��.. �Y�!'"''6
�� D SCONNFCT AND AB 1N.0 NJSEW ER _ STATE ENCROACHMENT
_ I
AND/OR DISPOSAL SYSTEM I-'�_4 � �I PERMIT NO.
-� SFPtiC EP
TANK SEAGE PIT OR .- -._.. --.-.-�-- -
PITS AND/OR ORAINFIE D INDUSTRIAL
-_f
CESSPOOL DRY�rJELL .- - -II WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00-i CHARGES
' -----^--� -
CONNECTION CHARGE FEE
OWNER'S PERMIT S I 1 , 00 - --- -
AUTHORIZATION TOTAL FEE � �� 2FIMRIJkSE,rENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRA
ON- APPROVALS DATE 4 t,'i:>rECTOR�S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING_DWELLING
70 THE PUBLIC SEWER
,- NEW HOUSE SEWER
SIGNED THIS _ DAY OF _. ..-19_x_•-
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT ! BUIL DIN' OR WORK
•° I SEPTIC TANK,.SEEP, PIT($)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL C] DRYWELL Cl
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WIYH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEVVERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/m, -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE QF DISCONNECT PLUG AND
CALIFORNIA OR TAT I AM THE LEGAL OWNER OF THE. ABOVEIi_BANDON_HOUSE_SEWER y_
DESCRIBED RESIDENTIAL PROPERTY, 73ACKFILL SEPTIC TANKS 0
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SIGNATURE SEEP, PIT(S) n_CES.SiPOOLS0
� _ ip .u.:- ,d' y`.,.:''_
OF PERMITTe:._ �' -✓
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
S{i�t
BY _t${Kr BY
DEPUTY DEPUTY
BY BY
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O - DEPUTY 'Jr` .'�- —' �D£PI.iTY