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Home My Public Portal About5703 SULTANA AVE_Sewer__ r / 6A6420APPLICA-'ION F"OA PERMIT X808 a sg COUNTY OF LOS ANGELES4" SEWER-SEWAGE.;DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING -, JOHN A. LAMBIE, Count F�sneer ADDRESS CASSATT D. GRIFFIN, Supt of Snilding LOCALITY NEAREST FOR APPLIC TQ FILL Il�I NEAR sr. LEGAL �' DESCRIPTION LOT-ItO OWNER / % .! ,✓-fi r' A MAIL BLOCK TRACT d4`dJ ADDRESS N0:OF BLDGS. SIi, x NOW ZE OF LOT ON LO CITY NO. USE OF ry BUILDINGS DISTRICT NO. GIt0fiP /r MAP PROCESSED BY CONTRACTOR I 3 " sL rzl ADDRESS. � a�7 '" ; , CONNECTION DATA CITY > (3`1EL.N0. P .'NATION "'d ' DEPTH ..�Y `b' 7�` r ,7 3 , ❑ STATE MANHOLE REFERENCE REGISTRATION NO. ® COUNTYLOWER NO, DESCRIPT NOF WORK FEE HOUSE SEWER CONNECTING TO �L s PUBLIC SEWER @ $3.00 TYPE OF CODE)CTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR 1`. URB ,' P.L. M.L.TO P.L. ° PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2,00 HOUSE SEWER CONNECTING TO {-'r' r P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 _C0.IMP. NO. / JOB NO. CONNECT ADDITIONAL BLDG.OR e-^ TRUNK PERMITNO. ROAD PERMIT NO. f WORK TO HOUSE SEWER @ $1:00 .,.+i ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 _PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE —, REIMBURSEMENT FEE NAMED CON- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXDATE A CONTRACT WITH THE IISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEW . i Y SIGNED THIS DAY OF f ig ' NEW HOUSE SEWER OWNER OR ,.'� '4 F CONNECT ADDITIONAL OWNERS AGENT I �•9 vu ;_- �t� J BUILDING OR WORK ADDRESS- 1 !A' p - ;a *�,_ . ,' ,`.- "�., SEPTIC TANK,SEEP.PIT(S) �"j —' `""� J - AND/OR DRAINFIELD l HEREBY ACKNOWLEDGE TIAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL © DRYWELL [IWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES-COUNTY AND STATE OF DISCOABANNNECT HOUSE SEWER CALIFORNIA OR THAT 1,AM THE LE. AL OWNER OF E ABOVE — DESCRIBED RESIDENTIA PROPEiITYr / % BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS Of PERMITTEE VALIDATION. EOBERT A. WOOD cr. Y.e. CASft SUPERVISING MECHANICAL ENGINEER